2. Personal information collected on this form is done so under the authority of the Freedom of Information and Protection of Privacy Act and is protected in accordance with that Act. Your personal information will only be used by authorized staff for the purposes of program delivery and/or bylaw enforcement, or for uses consistent with those purposes. Questions about the collection of your personal information may be referred to the Legislative Services Department at 250-746-2503 or by email at legislativeservices@cvrd.bc.ca

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