City of Bridgeport/Health Department Anti-Blight Appeal Form

Anti-Blight Appeal Form

An appeal may be filed within 10 days of receipt of the certified mailing of the fine notice, in accordance with Connecticut General Statutes § 7-152c.
Date

MonthDayYear
Date
Property Owner Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Property Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Energov Numer (Number can be found on the Violation Letter)
Please provide a detailed explanation of your appeal, including grounds and any relevant information.
Upload supporting documents (if any)

Cancelof
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