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2. Report a concern to Hazlet Township Public Works Department
   Please include any helpful details so that we can best respond.
4. Contact Information
6. First Name*
7. Last Name*
9. Address1*
11. Town*
12. State
13. Zip
15. Phone Number*
16. Email Address
18. Please checking relevant box(es) below:
20. 1. Pothole
    2. Damaged Curb
    3. Traffic Signals
    4. Weeds
    5. Abandoned vehicles
    6. Chemical discharge
    7. Water leaking
    8. Litter

    1. Road striping
    2. ADA Complaint
    3. Blocked drainage channel
    4. Street Lights
    5. Damaged sidewalk
    6. Traffic/Road signs
    7. Overhanging trees/shrubs
    8. Noise nuisance

    1. Hazardous parking
    2. Storm sewer leaking/blockage
    3. Water leaking on roadway
    4. Loose/protruding manhole cover
    5. Snow-related
    6. Recycling
    7. Brush
22. Brief Description (or other problem not listed)
24. Location of Problem
26. Upload any files/images
28. Thank you for alerting Hazlet DPW.
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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