City of Mingus, Texas

Appendix A — Nuisance / Sanitation Complaint Form

Referenced in Title VII – Health and Environment

Complainant Information

Name
Address
Phone
Email

Location of Suspected Nuisance / Violation

Address or Description of Property
Property Owner (if known)

Type of Complaint (Check all that apply)

Accumulation of Trash / Debris
Tall Grass / Weeds / Unsanitary Lot
Stagnant Water / Mosquito Breeding
Septic Leak or Odor
Open Burning / Smoke Complaint
Other (Explain Below)

Description of Problem / Evidence

Photos or Attachments

Attach any supporting photos or documents when submitting to City Hall or by email.

Complainant Signature

Signature		Date

For City Use Only

Received By		Date Received
Inspection Date		Inspector
Findings / Action Taken
Follow-Up / Disposition

↑ Return to Title VII – Health and Environment | Code Index