INFORMATION FORM

(Pursuant to Dunes City Nuisance Ordinance No. 108)

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INFORMATION FROM:  ____________________________________________________________

(Print Name and Address AND / OR Telephone No.)  

SUBJECT OF INFORMATION:

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NATURE OF INFORMATION: 

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INFORMATION PER NUISANCE ORDINANCE #108

1.      ANIMALS

2.       PUBLIC SAFETY (Unsafe Buildings)

3.       VEHICLES (Discarded / Inoperable)

4.       PUBLIC HEALTH (Debris accumulation / stagnant water /

pollution of a body of water/unsanitary conditions.)

5.       PUBLIC PEACE (Unreasonable Noise)

6.       OTHER (Unremunerated nuisances)

COMPLAINANT SIGNATURE or PHONE#___________________________________________(DATE)_________

RECEIVED BY (DUNES CITY):_____________________________________________________________

 

                                         DATE: ______________