2. Hampton County Maintenance Request Form:
   Use this form to request maintenance. Maintenance must be at a county-owned facility. The exact reported location/building address is required. Please use one form per request
4. Date & Time:*
6. 
   Contact Information
8. Department Making Request:*
   -- Select One --Administrator's OfficeAnimal ShelterAssessorAuditorBoard of Elections and Voter RegistrationBuilding & GroundsBuilding Dept. & PermitsCentral Dispatch (E911)Clerk of CourtCode Enforcement (Landfill)Code Enforcement (Veh. Reg.)CoronerCouncil on AgingCounty Council/Clerk to CouncilDelinquent TaxDetention CenterEconomic DevelopmentEmergency PreparednessEmergency ServicesFinanceFire DepartmentGrants AdministrationHuman ResourcesInformation TechnologyLandfill/Solid WasteMagistrate CourtMaintenance ShopProbate CourtRecreation DepartmentRecycling/Solid WasteRisk ManagementRoads & BridgesSheriff's DepartmentTreasurerVeteran's Affairs
10. Work requested by:*
12. Phone Number & Email Address:*
14. 
    Exact Location of Requested Maintenance:
16. Please describe the work being requested:*
18. Address of building:*
20. 
    Maintenance Department Use Only.
22. Work Order No.:
24. Purchase Order #:
26. Date Order Received:
28. Parts/Materials Used:
30. Date Completed & Work Completed by:
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field