Code Compliance Referral | Town of Palisade

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Person Making Referral

First

Last

Mailing Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Primary Phone Number

Secondary Phone Number

E-mail Address

Confirm E-mail Address

Address of Concern

Address

Description of Concern

Description of violation concern (ie: weeds, rubbish, abandoned/unregistered vehicles, building/zoning, animal violation [barking dog, excessive feces, etc.], other nuisance):

Other Comments

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