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3. Asoc Permit/Form:
5. Complainant Information:
7. Complainant Name*
8. Date
   Date

   Date
10. Address*
12. City*
13. State*
14. Zip Code*
16. Geocode
18. Phone Number
19. Fax Number
21. Email Address
23. Reply Request*

    1. No
    2. Yes, please contact me by Phone
    3. Yes, please contact me by Email
    4. Yes, please contact me by Mail
    5. Yes, please contact me by Other (Please Describe)
25. Other (Please Describe):
29. Complaint:
31. First Date of Observance
    First Date of Observance

    First Date of Observance
32. Last Day of Observance
    Last Day of Observance

    Last Day of Observance
34. Observed Property Owner
36. Observed Property Address*
38. City
39. State
40. Zip Code
42. Geocode
44. Violation Type

    1. Zoning
    2. Floodplain

    1. Subdivision
    2. Community Decay

    1. Litter
    2. Other
46. Other (Please Describe):
48. Viewable From?

    1. Public Road
    2. Your property
    3. Other
50. Public Road
    Which Public Road?
52. Other (Please Describe):
56. Description of Alleged Violation*
    Please attach any supporting documents, photos, etc.
58. Attach supporting Files
59. Attach any Supporting Files 2
60. Attach any Supporting Files 3
62. THIS COMPLAINT FORM IS A PUBLIC RECORD
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit Submit and Print

* indicates a required field