CODE ENFORCEMENT, BUILDING CODE, ZONING OFFICER
                 DAMASCUS TOWNSHIP, WAYNE COUNTY, PENNSYLVANIA
              DAMASCUS TOWNSHIP, HCR BOX 339A, DAMASCUS, PA 18415
        (570) 224-4410     FAX: (570) 224-4940     e-mail: damascus@ptd.net
 
                           VIOLATION COMPLAINT FORM
Please fill out the requested information as completely as possible. The
complaint may be anonymous. This form may be mailed, faxed, or delivered in
person to the Municipal Building.

Complainant: _______________________________  Phone No. ___________________

Date Complaint Filed: ______________  Date of Violation:  ____________________

Name of property owner where violation occurred: _____________________________

Exact Location of Violation (Road name, distance and direction from nearest 

intersection or landmark): ___________________________________________________

________________________________________________________________________

Tax Map Number of Property: _________________ Lot Size: __________________

Zoning District: __River __Rural Residential  __Industrial  __Neighborhood Dev.

NATURE OF VIOLATION: 

__Junk Appliances  __Burning of Materials other than wood or paper 

__Burning Residue   __Disturbance of Stream  __Disturbance of Wetlands  

__Floodway / Waterway Obstruction   __Garbage (Food, Household Wastes)  

__Junk / Abandoned Vehicles  __No Building Permit    __No Driveway Permit   

__No Sewage Permit  __No Use Permit   __Noise Nuisance  

__Noxious/Toxic Fumes, Runoff   __Road Encroachment (Road Right of Way)      

__Safety Hazard  __Scrap Metal  __Scrap Wood  __Screening     

__Setback Encroachment    __Sewage on Ground Surface or Sewage Odor  

__Uninhabitable Mobile Home   __Sign    __Old Tires  

__Trash, Rubbish, Worn, or Obsolete Manufactured Goods  

__Violation of Use Conditions Set By Township    __Water Pollution    

__Other (Specify) ___________________________________________________________

_____________________________________________________________________________

Ordinance and Section No. Violation: ________________________________________

Attach additional sheets if necessary

For Township Use: Date Received: _________________ By: ____________________ 

Forwarded to: __DEP  __PennDOT  __Supervisors  __PSP   __Conservation District   

__Code Enforcement Officer   __Zoning Officer     __Sewage Enforcement Officer

__Zoning Hearing Board   __Planning Commission    __PA Game /  Fish Commission         

__PennDOT   __ ________________________________________