Street Repair Request

Use this form to notify the City of a pothole or other street failure.

A street failure includes anything that impairs the normal flow of traffic, such as loose manhole covers, debris in the street or flooding.

Please submit a separate form for each request.
Provide as much information as possible about the location of the pothole or street failure.
Avoid vague descriptions like "One mile east of Carlisle" or "3 lights south of Deardoff".
When listing cross streets, please be exact (i.e., if the street failure is in a residential area, list residential streets as the cross streets, not the closest major intersection).

If you have difficulties with the form, please call 937-746-5001.

Date Observed*

Type of Street Failure*

Address of Street Failure (If Possible)

Cross Streets (One Street Name per Line)*

All of the information in this section is based on the cross streets listed above, so please make sure that the cross streets are accurate!

Where is the Failure?*

In Crossing

On Street

Where in Crossing?*

On which Street? (Must be one of the cross streets listed above)*

Please provide a direction of travel towards the street failure*

Is the street failure before or after the cross street?*

In Which Lane is the Street Failure?*

Please List any Nearby Landmarks*

Comments*

Your Name*

Your Telephone Number*

Your E-Mail Address*