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Public Works Department

publicworks@cityblm.org

309-434-2225

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Water Service
Waste Container Assistance ShortTerm
Waste Container Assistance LongTerm
Alley Plowing Assistance
Signature HereClick to Sign
03/08/2026Click to Sign
PatientReside_Yes
PatientReside_No
By signing this document I certify that the patient residing at the above address requires the use of potable water service at all times
By signing this document I certify that the above individual is unable to and should not move the garbage cart and recycling cart to
LongTerm
ShortTerm
By signing this document I certify that the above individual is unable to and should not remove snow from the public alley adjacent
Signature HereLicensed Physician Signature Will Sign Here
03/08/2026
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Additional Signatures Required