Environmental Health Service Request
Accessibility Help
Applicant's Details
Items marked
must be completed
Use Of The Form
Form Ref. No.
This form can be completed on-line.
When completed it should be submitted electronically back to the Council.
Please use the 'next' button (top right or bottom left of the form) to proceed to the next step rather than clicking on the navigation buttons down the left hand side of the form.
Applicant's Details
Please note:
We need to know your name and contact details in order that an officer can contact you to discuss your enquiry and to be able to obtain further information that may be helpful.
Your details will remain confidential and will not be divulged without your consent.
Anonymous enquiries or complaints cannot be dealt with.
Title
Forenames
Surname
Address Line 1
Address Line 2
Address Line 3
City / Town
County
Postcode
Telephone
Email Address
Is this the address where the problem is?
Yes
No
