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2. Site Evauluation to MODIFY 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 the streetlight luminaire at an unusual height or angle due to factors such as a tilted pole, an unusual pole placement, an unusually angled lamp arm, a lamp arm that is parallel to the road that the house is on or some other anomaly?

    1. Yes, the city will attempt to correct the problem by adjusting the streetlight luminaire and/or adding a shield to the lamp.
    2. No, proceed to question 2
16. Describe/ Draw the Issue*
18. 2. From Table 1, for the given streetlight model: A=______ P =___S =___ Is the house within A feet up or down the street from the streetlight?

    1. Yes, (a) if the streetlight is on a pole that is on the same side of the street as the house proceed to question 3, (b) If the streetlight is on a pole that is on the other side of the street from t
    2. No, request is denied
20. Please enter A=____, P=___, and S=____ in the box below:
22. 3. Is the distance from the edge of the street to the house PLUS the distance from the edge of the street to the streetlight less than P feet? Measured distance:

    1. Yes, the city will install a house-side shield
    2. No, request is denied
24. Please enter the measured distance in the box below for question 3:
26. 4. Is the distance from the edge of the street to the house PLUS the distance from the edge of the street to the streetlight less than S feet? Measured distance:

    1. Yes, the city will install a street-side shield
    2. No, request is denied
28. Please enter the measured distance in the box below for question 4:
32. Recommended Action
33. Budget Acct.
    11922-521002
35. Capital Cost to Modify Light
36. Funding Available
40. Table:
    
Leave This Blank:


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