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Hampton Creek Bog Flooding Damage Assessment Report

  1. City of Portage Logo
  2. Contact and Property Information
  3. Type of Property*
  4. Description of Damages and Documentation
  5. Water Levels

    Please report the level of water (in feet) associated with this incident.

  6. Describe Damages to Foundation (select all that apply)
  7. Describe Damages to Exterior Walls (select all that apply)
  8. Describe Damages to Interior Walls (select all that apply)
  9. Describe Damages to Flooring (select all that apply)
  10. Describe Damages to Windows and Doors (select all that apply)
  11. Describe Damages to Fixture (select all that apply)
  12. Describe Damages to Furnace (select all that apply)
  13. Describe Damages to Water Heater (select all that apply)
  14. Describe Damages to Utilities (select all that apply)
  15. Describe Other Damages (select all that apply and name feature below)
  16. Describe Other Damages (select all that apply and name feature below)
  17. Documentation

    Upload supporting photos and/or documentation. File types accepted include .jpg, .png, .pdf, .docx, .xlsx, .mp4, and .zip files.  If you have more than four files, please call (269) 329-4422.

  18. Leave This Blank:

  19. This field is not part of the form submission.