Form Center

2. Town of Holly Ridge
   2012 N Dyson Street
   P.O. Box 145
   Holly Ridge, NC 28445
   Phone: 910-329-7081
   Fax: 910-329-1593
3. 
5. This form will help us identify a problem in your area -- and fix it fast. Should a problem require urgent attention, please call us immediately. For a police emergency, dial 911. Otherwise, call 910-329-7081.
   Thank you for your assistance!
7. Contact Information
9. First Name*
10. Last Name*
12. Address1*
14. Address2
16. City*
17. State*
18. Zip*
20. Phone Number*
21. Email Address*
23. Please indicate the nature of your concern by checking the appropriate box(es) below:
25. 1. Abandoned vehicles
    2. ADA Complaint
    3. Blocked drainage channel
    4. Chemical discharge
    5. Damaged curb
    6. Damaged sidewalk
    7. Discrimination Complaint
    8. Dogs barking

    1. Fair Housing Complaint
    2. Hazardous parking
    3. Litter
    4. Loose/protruding manhole cover
    5. Noise nuisance
    6. Overhanging trees/shrubs
    7. Pothole
    8. Road striping

    1. Storm sewer leaking/blockage
    2. Street Lights
    3. Traffic/Road signs
    4. Traffic signals
    5. Water leaking
    6. Water leaking on roadway
    7. Weeds
27. Brief Description (or other problem not listed)
29. Location of Problem
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31. 1. Receive an email copy of this form.
32. Email address

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33. Submit Submit and Print

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