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2. Please select today's date*
   Please select today's date
4. Physical Address for Violation Inspection
6. Address1*
8. Address2
10. City*
11. State*
12. Zip*
14. Nature of issue(s) to investigate (Select all that apply)
16. 1. High grass or weeds
    2. Illegal dumping
    3. Junk vehicle
    4. Litter
    5. Vacant property
    6. Zoning
    7. Other
18. If 'Other' violation, please describe
20. Upload Photos or Documents (Optional)
22. Comments
24. If you wish to receive updates on this report, please provide your contact details.
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26. 1. Receive an email copy of this form.
27. Email address

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28. Submit Submit and Print

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