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Fix It Form

2. Report a concern to Hazlet Township Public Works Department
   Please include any helpful details so that we can best respond.

   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

    1. Litter
    2. Road striping
    3. ADA Complaint
    4. Blocked drainage channel
    5. Street Lights
    6. Damaged sidewalk
    7. Traffic/Road signs

    1. Overhanging trees/shrubs
    2. Noise nuisance
    3. Hazardous parking
    4. Storm sewer leaking/blockage
    5. Water leaking on roadway
    6. Loose/protruding manhole cover
    7. Snow-related
22. Brief Description (or other problem not listed)

24. Location of Problem

26. Upload any files/images

28. Thank you for alerting Hazlet DPW.

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field