JEFFERSON PARISH SERVICE REQUEST FORM
Please fill out the following information to request one of the services listed below:

All Service Requests containing your NAME and either your PHONE NUMBER or
E-MAIL ADDRESS will be reviewed and considered.

Anonymous submittals will not be accepted.

If the service you are requesting is an EMERGENCY or it is not listed below, please contact the appropriate DEPARTMENT directly.

One Service Request per submittal please.

* Service Requested By:
  
NAME (Example: John Brown):
STREET ADDRESS (Example: 123 Main St., Apt 12)
CITY (Example: Metairie)
STATE (Example: LA)
ZIP (Example: 70001)
PHONE NUMBER (Example 504-555-5555)
E-MAIL (Example: jbrown@isp.com)
  
* Service Requested:  Please select only one.
  
Clean Catch Basin or Drain
Investigate Need for New Drain Inlet
Pick Up Trash along a Canal or Ditch
Cut Grass along a Canal or Ditch

Request a New Traffic Sign
Request a New Stop Sign
        If a sign is missing or down, please call
        Traffic Engineering @ 736-6530 immediately.

Patch a Pothole
Street Light Outage

Pick Up Roadside Litter
Empty Litter Barrels

Trim Trees
Cut Grass Along Roadside
  
Describe Request - 1000 characters max.
  
* Service Location:   Exact Address, Hundred Block or Intersection is required.
  
LOCATION TYPE:
  
ADDRESS or HUNDRED BLOCK (Example: 1221):
  
STREET NAME
  
INTERSECTION (for Intersection Location Type only)
  
AREA
  
  
          
  
 

"Jefferson Parish hereby informs you that the Louisiana Public Records law requires that any and all information, complaints or documentation that you provide to the Parish is considered a public record that may be accessed by anyone requesting a copy of this information."