Form Center

2. First Name*
3. Last Name*
5. Email
6. Day Phone*
7. Secondary Contact
9. Address 1*
11. Address 2
13. City*
14. State*
15. Zip*
17. Problem*
    -- Select One --Drainage / Storm Water PollutionLitter / Illegal DumpingSewer Street RepairTrafficWater Supply
19. Examples
    • Drainage / Storm Water Pollution: Water flooding or collecting, sediment discharged from construction sites onto streets or to channels/bays, or illegal dumping of waste materials such as oil, trash, or leaf / grass clippings into storm water inlets or into channels / bays
    • Litter / Illegal Dumping: Debris on public property or right-of-way (Report litter on private property to the City Marshal's Office at 409-797-3647, for inspection and enforcement)
    • Sewer: Stopped / overflowing sanitary or storm sewer
    • Street Repair: Pothole, surface breaks, or irregularities
    • Traffic: Defective signal, damage traffic signs, or defective street light (You must enter the six-digit number found on the light pole below. These are reported to CenterPoint Energy, which you may also do at 713-207-2222)
21. Description of Problem*
    Include location and, for defective street lights, the six-digit lamp pole number.
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

* indicates a required field