Schwenksville Borough Complaint & Suggestion Form printable pdf download

Staff Use Only

Reviewed by: _____________________

Date: ____________________________

SCHWENKSVILLE BOROUGH

Response:

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COMPLAINT & SUGGESTION FORM

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Attach all written Responses

Type of Complaint: Please Indicate

Code Enforcement Complaint:

Request for a Repair or Replacement:

Complaint- Other (please specify):

_______________________________

Suggestion for Improvement:

NAME OF COMPLAINANT ____________________________________________________________________

ADDRESS ___________________________________________________________________________________

PHONE NO. _____________________________ EMAIL:_____________________________________________

TODAY’S DATE: _________________________DATE COMPLAINT OCCURRED: _____________________

FOR CODE ENFORCEMENT & ZONING COMPLAINTS:

COMPLAINT IS BEING FILED AGAINST

NAME (IF KNOWN) ___________________________________________________________________

ADDRESS/LOCATION__________________________________________________________________

FOR ALL OTHER COMPLAINTS, REPAIRS OR SUGGESTIONS

DESCRIBE BELOW IN DETAIL THE NATURE OF THE COMPLAINT, REPAIR REQUEST OR SUGGESTION. IF

COMPLAINT IS FOR A MALODOROUS ODOR OR NOISE BE SPECIFIC AS TO DATE, TIME, LENGTH OF

OCCURRENCE AND RESULT OF ACTION (I. E. HEADACHE, NAUSEA, AND LOSS OF SLEEP) PROVIDE

SPECIFIC LOCATIONS, TIMES, DATES AND DETAILS. ATTACH SUPPORTING MATERIAL.

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USE REVERSE SIDE IF NECESSARY

DATE _________________________

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SIGNATURE OF COMPLAINANT

Schwenksville Borough Complaint & Suggestion Form