2. Please fill out the following information to report a pothole, street, and/or sidewalk issue in Concord.
4. Where is the pothole, street, and/or sidewalk issue located?*
6. Provide a description of pothole, street, and/or sidewalk issue.
8. When did you notice this issue?
   When did you notice this issue?

   When did you notice this issue?
10. Please upload any additional files you feel might be useful.
12. Name
13. Email Address*
15. Address
17. City
18. State
19. Zip Code
21. Phone Number*
23. Thank you for reporting to us!
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25. 1. Receive an email copy of this form.
26. Email address

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27. Submit

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