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* DENOTES A REQUIRED FIELD

	1. Select the type of problem that you are reporting.
*Nature of Problem:	Please select an actionpublic worksBuilding permits, construction, inspectionsBusiness license, landfill permitspublic worksOther
	2. Briefly describe your request in the space provided. Please be as specific as possible.
*Description of Problem:
	3. Enter the address or location as well as the nearest intersection of the problem that you are reporting in the space provided.
*Location:
	Contact Information:
*Name:
*E-Mail:
*Address:
*City:
*State:
*Zip Code:
*Home Phone:
*Work Phone:
*Cell Phone:

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