570 - 923 - 2044

196 Main Street     PO Box 485     North Bend  PA     17760 US

chapman township

​CHAPMAN TOWNSHIP COMPLAINT FORM 

Forms are also available at the Township Office

​​COMPLAINT FORM

DATE OF COMPLAINT:________________________
ALLEGED VIOLATION OR COMPLAINT:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

COMPLAINANT INFORMATION: (MUST BE FILLED OUT)
NAME:_______________________________________
ADDRESS:_____________________________________
_____________________________________________
PHONE NUMBER:_______________________________

PROPERTY INFORMATION COMPLAINT IS ABOUT:
NAME:________________________________________
ADDRESS:______________________________________
______________________________________________
PHONE NUMBER:________________________________

ADDITIONAL INFORMATION OR COMMENTS:
______________________________________________________________________________
______________________________________________________________________________

TYPE OF VIOLATION: (FILLED OUT BY STAFF)

CODES:_________________ BUILDING:____________ ZONING:_______________
INVESTIGATION: (FILLED OUT BY STAFF) DATE:_______________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
RESOLUTION: (FILLED OUT BY STAFF) DATE:_______________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________