Catawba County Environmental Health Complaint Form

100 A Southwest Boulevard • PO Box 389 Newton, NC 28658 • 828-465-8270

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CATAWBA COUNTY ENVIRONMENTAL HEALTH
HAZARD/NUISANCE FORM

Note that any field with an asterisk is required.

Please complete the form with all required information. Providing the information will assist us in contacting you if more information is needed to investigate the complaint.

If you wish to be contacted by Environmental Health staff with the results of the investigation, please note this by checking the contact box. If you have any questions or need immediate assistance, please call (828) 465-8270.

If you wish to make a complaint anonymously, please visit the permit centers at the Government Center in Newton or the City of Hickory Administrative Building. An anonymous complaint form will be provided for your convenience.

Your name:*
Your address:		Unit:
City:		State: Zip:
Phone number:*
Email Address:*
Hazard or Nuisance Information
Owner's Name (If known):
Business name: (If applicable)
Site address:		City:
Nearest Cross Street:
What date/time did it occur?
Check all that apply :
	Tattoo Food Facility/Restaurant Local Confinement Septage Haulers	Sewage Spill/Failing Septic Tank Swimming Pool Water Supply Other (describe below)
Description of the hazard or nuisance:
Contact me with the results of the investigation:

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