Complaint Form

2. Complaint Form
4. Type of Complaint*

   1. Property

   1. Health

   1. Business
6. Location of Concern or Name of Business*
8. Owner of Property*
10. Information of Person Filing Complaint
12. First Name
13. Last Name
15. Address*
17. City*
18. State*
19. Zip*
21. Phone Number
22. Work Phone Number
24. Email Address
26. Comments*
    Please give a short description of the problem you are reporting.
28. Please contact me as soon as possible regarding this manner.*

    1. Yes

    1. No
30. PERMIT SUBMISSIONS REQUIRED IN PERSON
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

* indicates a required field