Townhouses-CS010321 REQUEST/COMPLAINT FORM
COMPLAINANT INFORMA?ION AND TYPE[ OF COMPLAIN?:
Name: '-~. ~',,~& ~-"-(~ ~('~_ ~- ~ Address:
Home Phone: c~ -~ A- ~ 5 c[ _ O~ ~.~ 5~) Work Phone:
BUILDING INSPECTIONS ENV. HEALTH FIRE
Accessory Structure Garbage Address Numbers
~'- Alleys/Sidewalk High Grass/Weeds Fire Lane
Debds/'l'rash (blowing) Illegal Dumping Hydrant Mnt.
Extedor Structure Mosquito Other
Fence Stagnant Water
Handicap Parking Vehicle (junked
Home Occupation parked in driveway)
Roadside Vendors Other
Signs/Banners
Trees/Shrubs Overhanging
Vehicle (junked parked on grass)
other
Date/Time of Offense (if aptpticabte):
PROPERTY OWNER/OCCUPANT INFORMATION:
Name: Address:
Home Phone: Work Phone:
Pdor Warnings/Citations Issued: Yes No
COMMENT/ACTION TAKEN: (Attach 2'~ sheet if necessary)
Complaint Closure Date: Complainant Notified with Results: Yes No
Type of Notification: Personal Phone Conversation: ~ Left Message:
(~/25/00)