Name of Requestor:

Address of Requestor

Phone Number

Email address

Proposed Street Light Location

Is there currently a utility pole at the location?*

Yes No

If yes, what is the Pole number (found on the pole)?

Requested Streetlight is to be located at the Intersection of:

If Streetlight is not to be located at an intersection, installation is requested at (nearest street address):

Reason you feel the Street Light is necessary:

Please obtain signatures of all property owners within five hundred (500) feet to the location(s) noted in the application. A majority of the affected property owners must have signed this petition. This link also contains a copy of the City's streetlight policy and a paper copy of the request form.

Street Light petition (pdf)