Human Health Hazard Complaint Form

The definition of a Human Health Hazard, defined in WI Statutes 254:
“Human Health Hazard means a substance, activity or condition that is known to have the potential to cause acute or chronic illness or death if exposure of the substance, activity or condition is not abated.”

If you would like to file a complaint, request, or report, doing so will create a public record that is subject to disclosure pursuant to Wisconsin public records law.

Langlade County Health Department
Chapter 10 Langlade County Ordinances

Your Name

First Name

Last Name

Your Email

Your Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Phone Number

(###)

###

####

Description of Health Hazard

Location of Health Hazard

Address of Health Hazard

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Property Owner Name

Property Owner Phone

(###)

###

####

Signature of Complaint

(digital signature)

First Name

Last Name

Date

YYYY