SW Citizen Request Form

Please enter information about yourself

Tell us about your County Solid Waste Request

Remember MeCan I remain ANONYMOUS when I make a complaint?NOT IN MOST CASES. Senate Bill 60 was signed and put into effect July 1, 2021,changing the state law to now require a person to provide his or her name and address whensubmitting a complaint, and any information you provide will become public record. Theexception is if the code enforcement officer has reason to believe the violation presents animminent threat to public health, safety or welfare or imminent destruction of habitat orsensitive resources; in only those cases can complaints be made anonymously.

First Name*

Last Name*

Business

Bldg/House #*

Street Name*

Apt/Suite

City*

Zip*

Phone # format

Primary Phone #*

use xxx-xxx-xxxx

Problem*

If an error is received regarding the location street beinginvalid please click the grid icon to right of the locationstreet name field and search for a valid street name.Use Requestor AddressPROBLEMS? Please call 386-943-7889- Location of the problem -

Bldg #*

Location Street Name (where Request is Desired)*

Loc City*

Nearest Cross Street

Please provide a brief comment (100 character max)*

Category*