Address of the Violation(s)*

Do you wish that this complaint be anonymous?* Do you wish that this complaint be anonymous?* Yes No

Details of the Complaint (be specific)*

Storm Water Complaints: Do you see signs of water contamination in the storm water system such as discoloration, an oily sheen, solids/floatables? Or, if you witness an individual or individuals discarding/ pouring liquids into the storm water system please report. Please describe the issue:*

Are there any known or suspected hazards at this location? (I.e. dangerous or unstable residents, dogs, criminal activity, etc.)* Are there any known or suspected hazards at this location? (I.e. dangerous or unstable residents, dogs, criminal activity, etc.)* Yes No Uncertain

If yes, please identify the hazard in detail

Complainant Information

Name of Applicant*

Mailing Address*

City*

State*

Zip*

Daytime Phone Number*

Email

Can the violation be seen from the Village Right of Way* Can the violation be seen from the Village Right of Way* Yes No

If not, what is the best vantage point?

Is the complaint about a neighbor?* Is the complaint about a neighbor?* Yes No

Do you grant the Code Enforcement Officer permission to enter upon your property for viewing the violation?* Do you grant the Code Enforcement Officer permission to enter upon your property for viewing the violation?* Yes No

If not, why?

Will you, the complainant, testify in court, should the need arise?* Will you, the complainant, testify in court, should the need arise?* Yes No

If you have photos, or other related information, that can be used as evidence of this violation, please submit them with this form. The submitted documentation will become part of the complaint file.

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