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Water & Sewer Dept Request Form
Requests for the Water & Sewer Department to perform general maintenance can be made by completing the following information.
Choose from the following:
Checkboxes
Checkbox Description
Checkboxes
Checkbox Description
Sewer Backup
Sewer Odor
Water Meter Repair
Dirty Water
Water Leak
Water Main Break
Water Odor
Water Pressure
All Other Sewer Complaints (please explain below)
All Other Water Complaints (please explain below)
Please provide the following information:
Field Description
Field Data
Required Field
Name:
required
Email:
required
Address:
required
City:
required
State:
Zip:
Phone:
required
Alt Phone:
Fax:
Organization:
Please give exact location of job request (if different from address):
Please give brief descripition of work requested:
Additional comments:
City of Highland Illinois, 1115 Broadway, P.O. Box 218, Highland IL 62249-0218 | 618-654-9891 |
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