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Request for Repair of Sidewalk or Other Access Improvement <br />to Public Right of Way <br />Date: <br />Name: <br />Address: <br />Telephone: Cell: <br />Email Address: <br />Street address of the problem location (please be as specific as possible): <br />Please put an "x" in all boxes that identify the problem: <br />❑ sidewalk broken <br />❑ sidewalk unusable due to <br />❑ debris ❑ tree roots ❑ shrubbery or other plant growth <br />❑ gravel ❑ trash ❑ rocks <br />❑ other: <br />(please describe) <br />❑ sidewalk impassable due to overhanging branches <br />