Problem Location

Street Number and Name:*

*

Address Line 2:

City:*

State:*

Zip Code:

Complaint Type*

Property Maintenance

Fire Code Violation

Complaint:*

High Grass / Weeds Sidewalk shoveling Hoarding Trash / Debris Drainage

Illegal burning Non-operating vehicles Dilapidated structure Vacant Structure Other (explain below)

Brief Description*

Photograph:

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Your Information (Complainant information is confidential)

Name:*

Street Number and Name:*

Address Line 2:

City:

State:

Zip Code:

Phone Number:*

Fax Number:

Email Address:

Preferred Contact Method:*

Do NOT contact me Email

Do you give the inspector permission to view the complaint from your property?*

Yes

No

Electronic Signature
(Please type your full legal name)*

Acknowledgement*

I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this complaint.