COMPLAINT FORM

COMPLAINT FORM
PREMISES
Fill out all required fields and provide as much detail as possible SECTION 1 Premises to be Investigated (Required)

PLEASE INCLUDE CORRECT HOUSE NUMBER TO EXPEDITE INVESTIGATION. SECTION, BLOCK AND LOT IS OPTIONAL
Property Address*
Date*

MonthDayYear
Date
Premises type*

ResidentialCommercialIndustrialOther
COMPLAINANT INFORMATION
Name

First NameLast Name
Phone number(s)
Email Address
example@example.com
Address

Street Address (Please include your house number)

Street Address Line 2

Town, State, ZipState / Province

Postal / Zip Code
VIOLATIONS
Select all that apply*

Overgrown Lots (grass in excess of 12 inches high)Rubbish, Trash, or Junk PileAnimal or Vegetable Matter (odor)Abandoned White Good(s)Loose Animals (dogs, chickens, etc.)Junked Vehicle(s)Minimum Housing IssuesDangerous or Vacant BuildingStructure, Fence, Etc. - No PermitsBurning of Limbs, Leaves, Etc.Open Storage (Including indoor furniture on porches)Loud Noise/Music (Between 9pm-6am)Other (Please Explain)
INVESTIGATION DETAILS
OFFICE USE ONLY
Date received

MonthDayYear
Date
Received by
COMPLETED COMPLAINT FORMS MUST BE SUBMITTED TO THE TOWN OF SWEPSONVILLE CODE ENFORCEMENT

Town of Swepsonville Town Hall 2747 Darrell Newton Drive Graham, NC 27253 Phone: 336-578-5644
Should be Empty:

PREMISES