Date: Daytime Phone:
Name: *
Address: * City: * State: * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip code: *
Email:
If yes, which department: Board of SupervisorsDept. of Environmental QualityDevelopment ServicesDOT - Community RelationsDOT - OperationsNatural Resources, Parks and RecreationOther
a. Complaint tax code/address: *
If no address, the drainage problem is located near the cross streets of:
Describe the location of the problem in relation to the location information above: *
b. Responsible party tax code/address: *
a. Who caused the drainage problem?
Neighbor New Subdivision Other Please specify
b. Cause of the drainage problem (check all that apply):
a. Name of subdivision:
b. Is the cause of the drainage problem (please check all that apply):
a. Is the cause of the Watercourse Problem (please check all that apply):
a. Briefly describe the drainage problem:*
Referred from Page:
201 N. Stone Avenue, 9th Fl. Tucson, AZ 85701 Phone: (520) 724-4600 Fax: (520) 724-4621 Customer Service Hours: 8:00AM - 4:00PM