Environmental Health Complaint / Referral Form

The form below may be used to submit or refer a complaint of a Sanitary Code violation to the Environmental Health Division.  Alternatively, you may print a paper copy of the form and send it by mail or fax.

Environmental Health Complaint / Referral Form (paper copy)

Blocks marked with an asterix (*) are required.  Please note that a place name (if a public place), street address, or tax map number is also required.  Tax map numbers can be found using the Cattaraugus County Real Property Parcel Viewer.

Name of the person filing the complaint

Address of the person filing the complaint

Town or City, State, and Zip Code where the person filing the complaint resides

Telephone number of the person filing the complaint

Email address of the person filing the complaint

Check yes if you would like to remain anonymous during the investigation of your complaint

Describe the nature of your complaint or referral. Please include as much detail as possible. You may be contacted for more information if necessary.

If complaint is concerning a public place, enter the name of the place. Leave blank if complaint is concerning a private property.

Street Address where the complaint is located (if known)

Tax map number of the parcel where the complaint is located. (these may be found using the Cattaraugus County Interactive Parcel Viewer linked at the top of this page)

Town or City where the complaint is located

Owner or occupant of the property

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