City of San Bruno
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Reporting Damage on City Property

This form is used to report any type of damage that has incurred on City streets.

DATE:
TYPE OF STREET OR PROPERTY DAMAGE :
POTHOLE STREETLIGHT OUTAGE
TRAFFIC LIGHT OUTAGE SIDEWALK DAMAGE
SIGN POLE DAMAGE GRAFFITI
STREET PAINTING
OTHER (Please describe if other)
   
FIRST NAME:
LAST NAME:
HOME ADDRESS:
CONTACT NUMBER:
   
APPROXIMATE ADDRESS OF DAMAGE:
   
IF SIDEWALK DAMAGE, WAS A STREET TREE INVOLVED? YES NO
   
BRIEF DESCRIPTION OF DAMAGE :
(INCLUDE APPROXIMATE WIDTH AND DEPTH OF POTHOLE: INCLUDE APPROXIMATE HEIGHT OF SIDEWALK LIFT, ETC.)
   
YOUR EMAIL ADDRESS: