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2. Site Evaluation to ADD a streetlight
4. Street Name:
5. Pole No:
6. Requested Date:
   Requested Date:
8. Contact:
9. Phone Number:
10. Evaluation Date:
    Evaluation Date:
14. 1. Is this request due to a potential road or traffic hazard such as: an intersection or crosswalk, school zone, fire station, bridge abutment, cul-de-sac, wheelchair way etc.?

    1. No, proceed to question 2
    2. Yes, proceed to question 3
16. 2. Are there no existing poles on which to mount a light or other high costs?

    1. No, proceed to question 4
    2. Yes, request is denied
18. 3. Is the distance to the next streetlight greater than 150 feet?

    1. No, request is denied
    2. Yes, request is approved
20. 4. Is this a busy primary street (4 lanes)?

    1. No, proceed to question 5
    2. Yes, proceed to question 7
22. 5. Is this an average suburban street?

    1. No, proceed to question 6
    2. Yes, proceed to question 8
24. 6. Is this a rural public street or public street with limited through traffic?

    1. No, request is denied
    2. Yes, proceed to question 9
26. 7. Is the distance to the next streetlight greater than 250 feet?

    1. No, request is denied
    2. Yes, request is approved
28. 8. Is the distance to the next streetlight greater than 300 feet?

    1. No, request is denied
    2. Yes, request is approved
30. 9. Are there 2 or more abuting residences within 150 feet?

    1. No, request is denied
    2. Yes, proceed to question 10
32. 10. Is the distance to the next streetlight greater than 500 feet?

    1. No, request is denied
    2. Yes, request is approved
36. Recommended Lighting
37. Budget Acct.
    11922-521002
39. Capital Cost to Install Light
40. Funding Available
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42. 1. Receive an email copy of this form.
43. Email address

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