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Department of Public Works Service Request Form

Welcome to the Belmar Public Works Service Request Form. By filling out the form below, citizens can direct comments or request to the Department of Public Works for further action. Please be sure to enter your name and Email address and choose from one of the items listed below.

Reason For Submission:
 Plowing Complaint
 Pot Hole Repair Request
 Property Damage Notification
 Recycle Pick Up Miss Notification
 Beach Issue
 Plowing Complaint
 Water/Sewer Problem
 Storm Drain Cleanout Request
 Street Llight Out Notification
 Street Sign Request
 Street Sweeping Request
 Tree Cutting/Trimming Request
 Trash Pick Up Miss Notification
 Other:
First Name*
Last Name*
Email*
Address
City
State
Zip Code
Telephone*
Mobile
Location
Your Message