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2. First Name
3. Last Name
5. Phone Number
6. Email Address
8. Mailing Address
10. City
11. State
12. Zip Code
14. Illicit Discharge Address / Location Description*
16. Date & Time Witnessed*
    Date & Time Witnessed

    Date & Time Witnessed
18. Description of Possible Violation*
20. Upload photo

    Files must be less than 5 MB.
    Allowed file types: gif jpg jpeg png.

22. Additional Information

    You may submit an offline reporting form (PDF) or picking it up from the Building/Land Use Department.

    Completed forms shall specify the location, date and time of an illicit event(s) and may be emailed or mailed/dropped off at Town Hall addressed to Department of Public Works, Attention: Director of Public Works.

Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field