Street Department

395 S. Main St.

Camp Verde, AZ 86322

928-567-0534

Fax: 928-567-1540

Storm Water Management

Citizen Complaint Form

Date:_______________________

Requested By:________________________________________________

Address:_____________________________________________________

Phone Number:_______________________________________________

Location of Complaint:_________________________________________

Type of Call:

Storm Water:_________________________________________________

Trash Debris Dumped:__________________________________________

Staff Response (Action):___________________________________________________________________________________________________________________

Date of Action:________________

____________________________________

Signature Street Department Staff:

Please return this form to the address above or call the Street Department number for assistance.