2. In order to facilitate the review of noise incidents, this form will become part of the public record and will be shared with the facility subject to this complaint. It may also be shared with other parties, including persons, agencies and governments. Personal information collected in this form will be used for program delivery and / or bylaw enforcement and is consistent with the authority to do so under Section 26 (b), (c), and (e) of the Freedom of Information and Protection of Privacy Act, (the Act). By filling out this form you are consenting to the release of your personal information in accordance with Section 26(d)(i) of the Act. If you have questions or concerns regarding the collection or disclosure of your personal information please contact the FOI Coordinator, at 250-746-2503.
4. Noise Location
   provide a street address closest to where the noise was noted.
6. House Number
7. Street Name*
8. City or Town*
   -- Select One --Cobble Hill
10. When did the noise start?
    When did the noise start?

    When did the noise start?

    Enter the date and time

12. Noise Description*
    describe the noise
14. Is the noise still present?*

    select one

    1. yes
    2. no
15. Has the noise been persistent since you first noticed it?*

    select one

    1. yes
    2. no
17. When did the noise end?
    When did the noise end?

    When did the noise end?
    If applicable, enter date and time
19. First Name*
20. Last Name*
22. Contact Information
    optional
24. Address
26. City
27. Province
28. Postal Code
30. Telephone Number
31. Email
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field