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2. Thanks for helping the City of Burlington keep your neighborhood streets safe. Please use this form to report unsafe traffic issues witnessed on Skagit Street.

4. Name:
6. Do you want to be contacted by the City?

   1. Yes
   2. No
8. Contact Information:
10. Date & Time of Observation:
11. Where observed:
13. What you observed:
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15. 1. Receive an email copy of this form.
16. Email address

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17. Submit

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