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Berkeley Township Pothole Report Form
Use this form to report any potholes located on Berkeley Township Roads
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* Indicates required question
DATE
*
MM
/
DD
/
YYYY
First Name
*
Your answer
LAST NAME
*
Your answer
PHONE NUMBER
*
Helpful if need further information regarding the location of the pothole
Your answer
EMAIL ADDRESS
*
you can enter more than one email
Your answer
Area of Town
*
Bayville, Holiday City,Silver Ridge Pelican Island, South Seaside Park or Manitou Park
Your answer
Street Name of Pothole Location
*
Your answer
Nearest Cross Street/Intersection Business or House Number PLEASE BE SPECIFIC
*
Your answer
Your Property Address
*
Your answer
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