2. 
4. Your Contact Information:
6. First Name
7. Last Name
9. Phone Number (XXX-XXX-XXXX)
10. Email Address
12. Should we contact you with a resolution?
    -- Select One --By PhoneBy EmailNo need to follow up with me
14. Location of Concern:
16. House Number or Hundred Block
17. Street Name
18. Nearest Cross Street
20. Additional information to assist with locating the concern:
22. Property Type
    -- Select One --Accessory BuildingCommercial BuildingResidential BuildingVacant Lot
23. Type of Concern
    -- Select One --Junk, trash, or debris at curb areaJunk, trash, or debris on propertyJunk, trash, or debris in street area
25. Additional Information to Assist with Investigating the Concern:
27. Upload photo (optional)
29. Granting Permission

    1. Yes, I grant permission

    By checking the box above, I understand that a site inspection may be necessary to provide city staff with facts related to the concern. If the concern is not in plain view or the property of concern is not accessible, I hereby grant permission to such persons to access my property to view the adjacent property concern if necessary. (This option is valid only if the Contact Information section is completed above.)
31. Please carefully review the information before submitting.
Leave This Blank:


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

    This field is not part of the form submission.

35. Submit

* indicates a required field