This form is to be used in the identification of any planning, building, or engineering related public nuisance which has been observed in the City of Cloverdale. All complaints will be investigated and, if necessary, abated in accordance with any applicable City Ordinance.

A complete description of the nuisance and its particular circumstances will greatly assist the City in evaluating the problem. Please fill out the following information regarding the nuisance being reported.

Date Observed:*

Address or Location:*

Description of Nuisance*

Thank you for completing this form. The City will investigate the nuisance and try to resolve the situation. If you so desire, fill out the information requested below so the City can contact you after our inspection and discuss our approach on this matter. Your cooperation is appreciated.

Name, Address, Telephone Number of Reporting Party: