2. 
6. First Name*
7. Last Name*
9. Address*
10. City*
11. State*
12. Zip Code*
14. Phone*
15. Email*
19. Type of Concern*
    -- Select One --Individual Lot (Covenants)Common Area (Facilities)

    "Individual Lot" concerns pertain to a neighbor's property and may be righted with a violation issued by the Covenants Department. "Common Area" concerns pertain to an issue on grounds maintained by either the Facilities Department or by an alternate service provider.
21. Nature of Concern

    1. Trash Can
    2. Litter / Debris
    3. Pet Waste

    1. Yard Maintenance
    2. Deteriorated Fence
    3. Deteriorated Wood Trim

    1. Unapproved Structure
    2. Vehicle (Flat Tire, Expired Tags, etc.)
    3. Trailer, Utility Trailer, RV
23. Brief Description
    NOTE: Covenants will promptly follow up on your concern, but keep in mind that voluntary compliance may take time. Your patience is appreciated. • Your identity will be kept confidential; however, the Homeowner may be informed that a concern was received from a neighbor. • You will not be contacted unless there is a question about your concern. • We are unable to provide an update as to the enforcement process regarding this concern. • Concerns with incomplete and/or vague information may not be investigated.
25. Nature of Concern

    1. Overgrown Vegetation
    2. Mowing / Trimming
    3. Tree / Shrub
    4. Soil Stabilization
    5. Blocked Drainage (PWC)

    1. Road Signs
    2. Litter / Debris
    3. Dumping
    4. Illegal Parking
    5. LRPRA Roadway / Sidewalk

    1. Snow Removal
    2. Street Light
    3. Utility
    4. Tot Lot / B-Ball Pad / Tennis Court / Pool
    5. Other
27. Brief Description
    NOTE: Facilities will review your request as soon as possible (typically within 24-72 hours, depending on the nature of your request and the overall volume received) and take one of the following actions: 1) Respond and/or take action to your concern/request. 2) Direct you to appropriate service provider-- e.g. Dominion Energy, VDOT, Washington Gas, Comcast, Verizon, PW Service Authority, USPS, or Prince William County. 3) Forward your information to the appropriate LRRPA department.
31. Location of Concern*
32. Photo of Concern

    Please attach a photo of your concern if relevant.

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field