City of Yreka Pothole Repair Request Form
Please fill out the fields below to submit
Street *
What is the name of the street the pothole is located on?
Your answer
Nearest Cross Street *
What is the name of the nearest cross street from the pothole?
Your answer
Nearest Address
Enter the nearest address to the pothole location.
Your answer
Latitude
If known, enter the Latitude of the pothole in decimal degrees.
Your answer
Longitude
If known, enter the Longitude of the pothole in decimal degrees.
Your answer
Email
Optional: Enter your email to be notified when the pothole repair has been completed.
Your answer
Phone Number
Optional: Enter your phone number to be notified when the pothole repair has been completed.
Your answer
Submit
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