Berkeley Township Pothole Report Form
Use this form to report any potholes located on Berkeley Township Roads
Date & Time *
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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