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2. 
4. COMPLAINT FORM
6. Please indicate the nature of your problem by checking the appropriate box(es) below:
8. Zoning Department - Kathleen Moss, Administrator

   1. Animal Husbandry
   2. Signs
   3. Illicit Discharges

   1. Unregistered/Derelict Vehicles
   2. Construction Site Stormwater
   3. Other
10. Complaint Submitted By:
12. First Name*
13. Last Name*
15. Address1*
17. Address2
19. City*
20. State*
21. Zip*
23. Phone Number*
24. Email Address*
26. Brief Description (or other problem not listed)*
28. Location of Problem or Street Address of Problem*
30. Occupant and Contact Information If Known
32. First Name
33. Last Name
35. Street Address
37. Phone Number
39. Email Address
41. Color of House or Building (if applicable)
43. File or Image Upload (if applicable)
45. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
47. Electronic Signature*
49. Date*
    Date
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field