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2. 
4. Name*
5. Date*
7. Phone Number
8. E-mail Address*
10. Address/Location of the Pothole*
12. Location Description

    Example: The pothole is located in the middle of the inside, north bound lane.

14. Pothole Size*

    1. Small (the size of a dinner plate)

    1. Medium (the size of a small suitcase)

    1. Large (larger than a small suitcase)
16. Photo
17. Photo

19. Thank you for making a report of a pothole in the City of Richland Hills. Public Works staff will have the pothole repaired within 72 hours, excluding weekends, holidays and any unforeseen water or wastewater emergencies.

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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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