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| Your Address: | | | Unit: | |
| City: | | State: | | Zip: | |
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| Best Time to Call: | |
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| Owner's Name: | |
| Address of Concern: | |
| Closest Cross Street: | |
| What time did you observe the situation? |
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| Abandoned Vehicles |
| Air Quality Hazards |
| Animal Care and Regulations |
| Wildlife Damage |
| Business Operating Without a License |
| Environmental Health (Food Facility Complaints) |
| Flooding or Levee Problems |
| Hazardous Materials |
| Housing Conditions |
| Illegal Construction or Occupancy |
| Illegal Dumping |
| Road and Sidewalk |
| Unsanitary or Unsafe Premises |
| Weights and Measures |
| West Nile Virus |
| Zoning Violations |
| Other (describe below) |
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