2. 
4. SUBMIT A POTHOLE, SIDEWALK OR DRAINAGE CONCERN
6. NAME:*
8. EMAIL*
9. CONTACT PHONE*
11. ADDRESS
13. CITY
14. STATE
15. ZIP
19. DESCRIPTION & LOCATION OF CONCERN*

    Please be as specific as possible in regards to the concern and location (street name, cross-sections of roads, etc).

21. PHOTO UPLOAD

25. Thank you for your submission. One of our employees will contact you if any additional information is needed regarding this concern. 

    If you should have additional questions in the meantime, please contact Daphne Public Works at 251-620-2100.

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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field