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2. Streetlight Modification Request
   Please submit your request to add, modify, or remove a streetlight using the form below. Your response will be forwarded to the Public Works Department for review. We strongly encourage you to review the City's Streetlight Policy, especially Section 4.4, before submitting a modificaion request.
   
   For more information, please visit our project page at LebanonNH.gov/Streetlights.
4. Requested By:
6. First Name*
7. Last Name*
9. Address
11. Email Address*
12. Phone
14. Type of Request:*

    1. ADD a streetlight
    2. MODIFY a streetlight
    3. REMOVE a streetlight
16. ADD a streetlight at *
18. MODIFY a street light at:*
    so as to redirect or block direct light from this lamp shining into a window of the applicant's residence at the following street address:
20. Street Name and Number*
22. REMOVE a street light outside the applicant's residence located at: *
24. Pole Number/Unique ID*
    Please visit our Lebanon Street Light Map to find the streetlight ID number matching your location.
26. Please check the items that match the reason for your request.

    1. Traffic volumes
    2. Spacing of intersecting streets
    3. Lighting in adjacent areas
    4. Night-to-day crash ratios
    5. Geometric Factors (i.e. driveways, parking, sight distances). See 4.4.1e
    6. Operational Factors (i.e. pedestrian activity) See 4.4.1f
    7. Pavement markings and signs can serve as substitute
    8. Intersection, roundabout, mid-block crosswalk, parking facility
    9. Potential for wrong-way movement, twilight/nighttime pedestrian volume (see 4.4.4)
    10. Railroad Crossing Point
    11. Light Trespass (spill light, glare, sky glow). See 4.4.6
    12. Animal and Plant Impacts
    13. Financial Impacts
    14. Prevention of criminal activity and disorderly conduct
    15. Aesthetics
28. Reason/Explanation of Request*
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field