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2. Illicit Discharge - Illegal Dumping - Stormwater Complaint Form
   Please report emergency violations to the Madison County Property Code Enforcement Department at 731-423-2041.
4. Confidentiality Statement
   Any and all information submitted, will remain confidential about the identity of the individual completing this form.
6. Asterisk (*)
   Any field marked with a red asterisk is required and must be completed to submit this form.
8. Contact Information For Individual Submitting Form
10. First Name*
11. Last Name*
13. Address1
15. City
16. State
17. Zip
19. Phone and/or Email*
23. Violation Information
25. Property Address of Violation*
27. City
28. State
29. Zip
31. Type of Property*
    -- Select One --Select OneUnknownResidentialCommercialIndustrialOther
32. Type of Violation*
    -- Select One --Select OneIllicit DischargeIllegal DumpingStormwater Other
34. Illicit Discharges May Include; But Not Limited Too: Sewage, Debris, Chemical Disposal, Industrial Waste, Oil Disposal and/or Similar Discharges.
36. Description of Violation*
    Please be as descriptive as possible about any vehicles, license plates numbers, individuals and/or violation activity witnessed.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field