Street Light Application Form

Name *

Address *

Telephone (home) *

Telephone (other)

Email *

Location of Streetlight to be added or removed *

Reason for Addition *

Near sharp curve

Near slope or elevation that may obstruct view

High Traffic Area

Other dangerous situation

Recreational facility

Other (please specify reason)

Reason for application *

Is this request from a developer? *

Yes

No

Has the development been approved by Plan360? *

Yes

No

Type of residential development *

Address of the development *

Describe the work that has been done on the development as of application date *

Road pavement completed *

Yes

No

Please specify date of completion *

Date of application *

I hereby certify that the information provided in this form is true to the best of my knowledge.