Code Enforcement Investigation Request

2. Reporting Party Information
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   An incomplete form may prevent processing

4. Date:*
   Date:

6. First Name*

7. Last Name*

9. Contact Phone Number:*

10. Alternate Phone Number:

12. Your Email:

14. Address1

16. Address2

18. City

19. State

20. Zip

22. Confidentiality Requested:*

    1. Yes
    2. No

24. Location of Concern

26. Site Address:*

28. Parcel Number*

30. Description of Concern*

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

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