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Form analysis
1 forms found in the DOM

Name: ServiceRequestFrm — POST /Portal/CreateSR

<form action="/Portal/CreateSR" enctype="multipart/form-data" id="ServiceRequestFrm" method="post" name="ServiceRequestFrm">
  <div class="main">
    <input type="hidden" name="IncidentCountry" class="form-control" id="IncidentCountry" title="Country">
    <input type="hidden" name="IncidentState" class="form-control" id="IncidentState" title="State">
    <input type="hidden" name="IncidentCity" class="form-control" id="IncidentCity" title="City">
    <input type="hidden" name="IncidentCounty" class="form-control" id="IncidentCounty" title="County">
    <input type="hidden" name="IncidentStreet" class="form-control" id="IncidentStreet" title="Street">
    <input type="hidden" name="IncidentZip" class="form-control" id="IncidentZip" title="Zip">
    <input type="hidden" name="XCoordinate" class="form-control" id="XCoordinate" title="XCoordinate">
    <input type="hidden" name="YCoordinate" class="form-control" id="YCoordinate" title="YCoordinate">
    <div id="fileAttachments">
    </div>
    <input type="hidden" class="form-control" id="incidentAddressInput" disabled="">
    <input type="hidden" class="form-control" id="Description" disabled="">
    <input name="Zip" id="Zip" value=" " type="hidden">
    <div class="loader" id="loader" style="display:none">
      <div class="loader-box">
        <img src="../../Content/images/loading.gif" alt="">
        <h3>Please wait...</h3>
      </div>
    </div>
    <div class="alert alert-danger" id="errorMessage" style="display:none">
      <i class="glyphicon glyphicon-check"></i> An Error Has Occured try again later
    </div>
    <div id="parentDiv" style="">
      <div id="div0">
        <header>
          <i class="nexgen-service-request header-icon"></i>
          <h1 class="header-title">Report</h1>
          <div class="header-subtitle">A Service Request</div>
        </header>
        <div class="m-space">
          <p> To get started select a problem area from the list below to request service. Based on your selection, a list of Service Types will be shown.To view open services requests click the view button above. <strong> For all police, fire,
              medical, or other emergency, please call 911 immediately.</strong>
          </p>
        </div>
        <div>
          <div class="m-space">
            <h3 class="title">Select a Problem Area</h3>
          </div>
          <div class="row display-flex">
            <div class="col-sm-12 s-space">
              <button type="button" class="btn btn-primary btn-block btn-lg btn-icon display-flex-height" id="1" onclick="clickProblem(this);"> Building/Grounds <br>
                <small>Issues relating to building and grounds maintenance (ex. Lighting Issues, Broken Sprinkler)</small>
                <i class="nexgen-chevron-right"></i>
              </button>
            </div>
            <div class="col-sm-12 s-space">
              <button type="button" class="btn btn-primary btn-block btn-lg btn-icon display-flex-height" id="2" onclick="clickProblem(this);"> Garbage <br>
                <small>Issues relating to garbage and street cleanup (ex. Illegal Dumping, Missed Trash Pickup)</small>
                <i class="nexgen-chevron-right"></i>
              </button>
            </div>
            <div class="col-sm-12 s-space">
              <button type="button" class="btn btn-primary btn-block btn-lg btn-icon display-flex-height" id="3" onclick="clickProblem(this);"> Graffiti <br>
                <small>Issues relating to graffiti (ex. Building Graffiti, Bridge Graffiti)</small>
                <i class="nexgen-chevron-right"></i>
              </button>
            </div>
            <div class="col-sm-12 s-space">
              <button type="button" class="btn btn-primary btn-block btn-lg btn-icon display-flex-height" id="4" onclick="clickProblem(this);"> Health/Safety <br>
                <small>Issues relating to public health or safety concerns (ex. Roadkill, Hazardous Waste)</small>
                <i class="nexgen-chevron-right"></i>
              </button>
            </div>
            <div class="col-sm-12 s-space">
              <button type="button" class="btn btn-primary btn-block btn-lg btn-icon display-flex-height" id="5" onclick="clickProblem(this);"> Parking <br>
                <small>Issues relating to public parking lots and street parking (ex. Parking Meter, Handicap Issue)</small>
                <i class="nexgen-chevron-right"></i>
              </button>
            </div>
            <div class="col-sm-12 s-space">
              <button type="button" class="btn btn-primary btn-block btn-lg btn-icon display-flex-height" id="6" onclick="clickProblem(this);"> Sewer <br>
                <small>Issues relating to sewer and sanitary waste (ex. Sewer Overflow, Manhole)</small>
                <i class="nexgen-chevron-right"></i>
              </button>
            </div>
            <div class="col-sm-12 s-space">
              <button type="button" class="btn btn-primary btn-block btn-lg btn-icon display-flex-height" id="7" onclick="clickProblem(this);"> Sidewalk <br>
                <small>Issues relating to sidewalk (ex. ADA Compliance, Damaged Sidewalk)</small>
                <i class="nexgen-chevron-right"></i>
              </button>
            </div>
            <div class="col-sm-12 s-space">
              <button type="button" class="btn btn-primary btn-block btn-lg btn-icon display-flex-height" id="8" onclick="clickProblem(this);"> Streets <br>
                <small>Issues relating to streets and traffic (ex. Pothole, Traffic Light Outage)</small>
                <i class="nexgen-chevron-right"></i>
              </button>
            </div>
            <div class="col-sm-12 s-space">
              <button type="button" class="btn btn-primary btn-block btn-lg btn-icon display-flex-height" id="9" onclick="clickProblem(this);"> Water Issues <br>
                <small>Issues relating to water (ex. Water in the Street, Tap Water Color/Odor)</small>
                <i class="nexgen-chevron-right"></i>
              </button>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div>
      <button type="button" class="btn btn-success" id="btnNext">Next <i class="nexgen-chevron-right"></i></button>
    </div>
    <br>
    <div class="alert alert-danger m-space" id="mapValidationMessage" style="display:none">
      <i class="nexgen-warning"></i> Please select Address.
    </div>
    <div id="mapView" style="display:none;">
      <header>
        <i class="nexgen-service-request header-icon"></i>
        <div class="header-subtitle">Service Request</div>
      </header>
      <div class="m-space">
        <p> You can either drop a pin on the map or enter the exact location where the service is required. <strong> For all police, fire, medical, or other emergency, please call 911 immediately.</strong>
        </p>
      </div>
      <div id="mapPartial">
        <h3 class="title">Select a location on the Map, use current location or enter the address below.</h3>
        <div class="row">
          <div class="col-sm-15">
            <div class="form-group" id="addressView">
              <div class="form group input-group" id="addressSearch">
                <input type="text" class="form-control" id="srAddress" placeholder="Enter Incident Address" title="SR Address">
                <span class="input-group-btn" id="CurrentLocation">
                  <button class="btn btn-default" type="button" title="Address"><i class="nexgen-address"></i></button>
                  <button class="btn btn-default" type="button" id="UserLocation" title="Current location"><i class="nexgen-gis"></i></button>
                </span>
              </div>
            </div>
          </div>
        </div>
        <div class="m-space">
          <div class="google-map" id="sr-map" style="width:100%;height:400px;"></div>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

Hello! Toggle navigation

 * Report
   A Service Request
 * View
   Submitted Service Requests

Powered by nexgenlogo


PLEASE WAIT...

An Error Has Occured try again later


REPORT

A Service Request

To get started select a problem area from the list below to request service.
Based on your selection, a list of Service Types will be shown.To view open
services requests click the view button above. For all police, fire, medical, or
other emergency, please call 911 immediately.


SELECT A PROBLEM AREA

Building/Grounds
Issues relating to building and grounds maintenance (ex. Lighting Issues, Broken
Sprinkler)
Garbage
Issues relating to garbage and street cleanup (ex. Illegal Dumping, Missed Trash
Pickup)
Graffiti
Issues relating to graffiti (ex. Building Graffiti, Bridge Graffiti)
Health/Safety
Issues relating to public health or safety concerns (ex. Roadkill, Hazardous
Waste)
Parking
Issues relating to public parking lots and street parking (ex. Parking Meter,
Handicap Issue)
Sewer
Issues relating to sewer and sanitary waste (ex. Sewer Overflow, Manhole)
Sidewalk
Issues relating to sidewalk (ex. ADA Compliance, Damaged Sidewalk)
Streets
Issues relating to streets and traffic (ex. Pothole, Traffic Light Outage)
Water Issues
Issues relating to water (ex. Water in the Street, Tap Water Color/Odor)
Next

Please select Address.
Service Request

You can either drop a pin on the map or enter the exact location where the
service is required. For all police, fire, medical, or other emergency, please
call 911 immediately.


SELECT A LOCATION ON THE MAP, USE CURRENT LOCATION OR ENTER THE ADDRESS BELOW.





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