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Want Help from City Hall? <br /> Fill out this Checklist <br /> Pitch In! To make our City cleaner. Whenever TREES: <br /> you see a condition that needs to be corrected, Location <br /> use this form and bring it in or mail it to: <br /> Limbs too low 0 Dangerous limb ❑ <br /> City of Mounds View Hanging limb 0 Blocks traffic sign 0 <br /> 2401 Highway 10 <br /> Mounds View, MN 55112-1499 FIRE HYDRANTS: <br /> Location <br /> (Type or print) <br /> DATE: /21 A,'r / 9 9.3 Leaking ❑ Caps off 0 Needs painting 0 <br /> STREETS: fi'A n/i o ,, P9 R STREET LIGHTS: <br /> Location Location <br /> P//RA/ 4/6- d,or APPROACH Nits 61- inuCf. <br /> Holes ❑ Rough 0 Settled 0 Lamp out 0 Reflector damaged 0 <br /> Water 0 Bump❑ Loose gravel ❑ Pole damaged ❑ Globe damaged ❑ <br /> Poor drainage ❑ Manhole cover rattles 0 Wires, pins, insulators or crossarms <br /> Needs cleaning ❑ Mud on street ❑ dangerous 0 Needed ❑ <br /> SHRUBBERY: TRAFFIC SIGNS: <br /> Location Location <br /> Blocks traffic sign El Obstructs sidewalks❑ <br /> Blocks view of intersection ❑ Overgrown ❑ Bent ❑ Missing❑ Dangerous 0 <br /> Needs replacing 0 Needs painting 0 <br /> SIDEWALKS: Dirty ❑ Improper location ❑ Needed❑ <br /> Location <br /> PLAYGROUNDS: <br /> Holes ❑ Cracked 0 Tree roots ❑ Location <br /> Muddy El House service trench sunken 0 <br /> Equipment broken or vandalized 0 <br /> BALLFIELDS: Hazardous conditions ❑ <br /> Location <br /> Dangerous conditions 0 Vandalism ❑ Other pertinent facts or additional info: <br /> g '�RANe-Orn P9R� DoT/AP�ROAct/ � Nor <br /> Improper behavior by participants ❑ /MD R ,weF,vT iftWerfe# .auR/.c/ - ,SPR/x/c/ <br /> or spectators ❑ Other 0 ,PRi,vy sE/IV aA/ /N 7/fEP',Sr-rye nx,r A✓E <br /> To help serve you, we need to know: .BeE/v a ^4/6 17. <br /> • (z UJE r&' - fiFo.2 <br /> PRESCHOOL P/206/1•4P?} <br /> Name: AF/3 a/e- A/E F ek <br /> REFUSE COLLECTION: • <br /> Location Address 832/ Ai'v° `14)"13 O R S vE <br /> CI ✓/e 4/ <br /> Frequently not picked u <br /> Inadequate receptacleiFrequently scattered ❑ Phone No. 786-- /3d/ <br /> . <br /> THANK YOU FOR YOUR HELP! <br /> 9 <br />