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2. Location

   Please provide the address, or, parcel number, or property owner name and street for the location of the potential violation. 

4. Violation

   Please provide details of the potential violation. 

6. Anonynimity
   -- Select One --YesNo

   Do you wish to remain anonymous? 

8. Not Anonymous

   If you do not wish to remain anonymous and want to receive updates on the status of the potential violation, please fill in your contact information below. You do not need to provide both an email and phone, but include the method of contact you prefer if you have one.

   Note** Pursuant to the Freedom of Information-Privacy Acts (FOIPA) and North Carolina General Statutes Chapter 132, Public Records; this electronic mail message and any attachments hereto, as well as any electronic mail message(s) sent in response to it may be considered public record and as such subject to request and review by anyone at any time. 

10. Name
11. Email Address
13. Phone Number
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15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

* indicates a required field