Notice and S.O. Report.pdf - Hcnv.us

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Nuisance Complaint Form
HUMtsOLDT COUNTY CLERK
Date:
Address of allesed Nuisance:
Section of Ordinance complaint made on'. X",O 9" Q'LQ
Describe condition of property that lead to filing of comp
Are you providing photos or other evidence
If so please attach.
Yes
Are you the only complainant Yes )i no
If no list other complainants (provide printed name, signature, address, and telephone
number: (attach additional sheet if necessary)
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Signature:
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Print Name:
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Mailing Address:
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