2. First Name of person making complaint*
3. Last Name of person making complaint*
5. Address of person making complaint*
7. City*
8. State*
9. Zip*
11. Phone Number*
12. Email Address
14. Location of Complaint
15. Owner of Parcel if known
17. Address if known
19. Detailed Description of Concern
21. Do you agree?*

    By clicking "I agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I Agree
23. Signature of person filing complaint*
25. All complaints must include a phone number. The complaint will not be addressed if there is not a valid phone number listed.
27. Complaint #:
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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