Residential Code Violation Complaint Form

Your information

   
Your Name
(Last, First)
   
 
Street Address
   
 
City, State, Zip
   
 
Phone
   
 
E-mail
   
 
College Student?
     Yes     No
 
Relationship to property
    Occupant, neighbor, concerned citizen?

    

 

Code Violation

   
Type of Violation
    fire safety
    garbage
    high grass
    housing condition
    junk vehicle
    no heat
    no electricity
    open burning
    over occupancy
    parking
    sidewalk not shoveled
    water related
    vermin infestation
    other
 
Description of Violation
   
 
Street Address
   
 
Apt. No.
   
 
Rental Housing
     Yes     No
 

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