Borough of Pennsburg
76 West 6th Street

      www.pennsburg.us      

Office: 215-679-4546
Pennsburg, PA  18073                               Fax: 215-679-5140

Resident Concern Report
  
Please print out this form and fax, mail, or return to the above address.

  Date:______________________
 
 
Your Name:_______________________________________Phone #:____________________

 
Your Address:________________________________________________________________

 
Email Address:_______________________________________________________________

  Signature:___________________________________________________________________

 
Please describe specific nature of concern and include as many facts as possible:

  ___________________________________________________________________________

  ___________________________________________________________________________

  ___________________________________________________________________________

  ___________________________________________________________________________

 Location of concern:  ___________________________________________________________

This form is to be used for concerns regarding Code and other Borough Ordinance violations.  Written complaints assist the Borough in the follow-up and resolution of these types of issues. Anonymous complaints cannot be addressed due to enforcement issues. While every effort will be taken to keep names and/or information confidential, it cannot be guaranteed if enforcement action results in Court or hearing examiner proceedings. Depending upon the nature of the violation, you may be requested to testify at an enforcement proceeding.  The Borough of Pennsburg thanks you for your efforts in improving the quality of life for the community.
 

OFFICIAL USE


 Date Received: _____________________
 Concern Report #: ___________________
 Additional Information :_________________________________________________________
  ___________________________________________________________________________
  ___________________________________________________________________________
 
 Referred To:
£ Borough Office £ Code Enforcement £Police £ Engineering  £Streets £Tax
 £
Recycling  £Fire  £Sewer £Water £Other:_______________