EmailMeForm
Rowan County Environmental Health Complaint Form
Person and/or Establishment of Complaint
Include Address, City & Zip Code.
Township, Map Number and Parcel ID if available
Nature of Complaint
Direction of Property of Complaint
Owner of Premise Information
First
Last
Owner Address
Street Address
City
State / Province / Region
Postal / Zip Code
Owner Phone
###
-
###
-
####
Complaintant's Name
First
Last
Complaintant's Phone
###
-
###
-
####
FOR OFFICE USE ONLY
CDP Request Number
Date Incident Occurred
MM
/
DD
/
YYYY
Date Complaint Received
MM
/
DD
/
YYYY
Resolved Date
MM
/
DD
/
YYYY
Complaint Assigned To
