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               Town of Chapel Hill Logo                              Fire Department Patch               

     TOWN OF CHAPEL HILL
     Fire Department

     403 Martin Luther King Jr. Blvd.
     Chapel Hill, NC 27514-5705

     phone (919) 968-2781 fax (919) 932-2956
     www.townofchapelhill.org

Please correct the field(s) marked in red below:

If you would like a safety and security survey conducted on your dwelling units, please complete the following information. Your answers will be received by the Chapel Hill Fire Department's Life Safety Division. Someone will be in touch with you soon.

1
Your Full Name
 *
2
Your Email Address
3
Your Phone Number
 *
4

Requested Date(s) for Inspection
(must be at least 48 hours in advances, excluding weekends and holidays)

 *
5
What Type of Dwelling Is It
What Type of Dwelling Is It
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