Madison County Department of Building Inspections P.O. Box 1138 Danielsville, GA 30633 (706)795-6350
COMPLAINT FORM Date: _____________
Map _____
Parcel_______
Person Reporting Complaint:
Location of Complaint:
Name: ________________________________ Address: ________________________________ ________________________________ ________________________________
Owners Name: ___________________________ Address: ________________________________ ________________________________ ________________________________
Contact No.: ______________________________
Contact No.:_____________________________
(If any further directions need to be given for the location of complaint complete on back of form.) Is property a rental property? _________________
How long you have been there? _______________
Nature of Complaint: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Have these complaints been brought to the property owner’s attention? __________________________ If yes, explain the actions taken. ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Assigned to: ___________________________________
Date: __________________________________
