Property of Concern Request Form

Property Of Concern Request Form

Wright Township Municipal Building 321 S Mountain Blvd. Mountain Top Pa 18707 Phone 570.474.9067
Name*

First NameLast Name
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
The fields above are necessary in the event additional information is required. All personal information provided will be kept confidential when dealing with the responsible party(s)
Address of Concern*

Street Address

CityState / Province

Postal / Zip Code
Is the property*

OccupiedVacantUnknown
Occupants Name if Known:

First NameLast Name
Owners Name (if different than occupant)

First NameLast Name
Address of owner (if not the same as property of concern)

Street Address

Street Address Line 2

CityState / Province

Postal/Zip Code
Description of concern*
You may add up to 4 photographs of the concern here. ** NOT REQUIRED **

** NOTE** Files must be less than 10854kb and in one of the following formats pdf, doc, jpg, jpeg, png, gif
Cancelof
Is the concern visible from a public right-of-way?*

YesNo
Is the concern visible from your property*

YesNo
If yes do we have consent to enter your property to view the property in question*

YesNo
Action Taken:
Should be Empty:

Property Of Concern Request Form