Mineral County

By making this request for an investigation, I acknowledge that the health department may take all neccesary steps consistant with the appropriate laws to investigate and effect correction if such is warrented. Such action may involve referral to other agencies or legal action that may require the need for court appearance and testimony to collaborate the conditions stated in this complaint. *

Yes I acknowledge

No I do not acknowledge

What Agency?

Have you reported this condition to the person(s) responsible? *

Yes

Phone - Owner of Property (if different):

I herein request an investigation of the public health hazard or nuisance described below: *

Phone- Person(s) Responsible for the Condition: *

Environmental Services

Complaint Form (Online)

Date and time *

Email - Person requesting the investigation: *

Was this condition reported to another agency?

Yes

Please fill out this online complaint form for any concerns dealing with public health violations.

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Name - Person requesting the investigation: *

Health Department

Phone - Person requesting the investigation: *

Address - Person requesting the investigation: *

When?

Was this condition reported to the health department previously? *

Yes

Name - Person(s) Responsible for the Condition: *

Location (be specific): *

Name - Owner of Property (if different):

How long has the condition existed? *

Address - Owner of Property (if different):

Address- Person(s) Responsible for the Condition: *

Environmental Services

Complaint Form (Online)

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