Environmental Health Complaint Investigation Form

Use this form to report your public health ordinance complaint. Please fill out all information as completely and accurately as possible.

Complainant Information

Name
Address
City, State, Zip
Phone
Email Address
Best time to reach you

Complaint Location & Occupant/Facility

Name
Address
City, State, Zip
Phone

Owner / Landlord Contact

Landlord / Property Owner
Address
City, State, Zip
Phone
Was landlord contacted?
If yes, what date?
Complaint Description
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