2. If you wish to speak with someone about flooding issues in Coconino County, contact the Coconino County Community Development Engineering Division at (928) 679-8850.
4. Please provide the information requested below. All sections of this application must be completed (or marked as not applicable "N/A" where appropriate) or the application will not be accepted for review.
6. PROPERTY OWNER INFORMATION
8. First Name*
9. Last Name*
11. Phone (###) ###-####*
13. Email:*
14. Confirm Email:*
16. Do you want to be notified with issue updates?*

    1. Yes
    2. No
18. LOCATION OF DRAINAGE PROBLEM
20. Address*
22. City*
23. State
    Arizona
24. Zip*
26. Longitude and Latitude
27. Assessor's Parcel Number:*
29. Look up your APN
    Click Here
31. STORM EVENT DETAILS
33. Date of Flooding Event (mm/dd/yyyy):
    Date of Flooding Event (mm/dd/yyyy):
35. Cause of drainage problem (please check all that apply)*

    1. Altered or diverted flow
    2. Undersized culvert
    3. Culvert out of flow line (horizontally or vertically)
    4. Debris in wash
    5. Fence or wall in wash

    1. Erosion of wash
    2. Excavation in wash
    3. Fill in wash
    4. Graded property that altered flow
    5. Other, please specify
37. Other Description:
39. Have you reported this drainage problem to Coconino County before?*

    1. Yes

    1. No
41. With whom did you report the drainage problem?*
43. When did you report the drainage problem?*
    When did you report the drainage problem?
45. Upload Photos Here (Optional)
47. Photo 1
48. Photo 2
49. Photo 3
50. Photo 4
52. Certification*

    I certify that the information is, to the best of my knowledge, correct and represents a complete and accurate statement. By signing below, I agree to allow a Coconino County representative on site to review and verify the above information (if needed). I also certify that I am an authorized representative of the above property. By checking this box, I acknowledge the above certification

    1. Yes
    2. No
53. Today's Date (mm/dd/yyyy):*
    Today's Date (mm/dd/yyyy):
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field