VERIFICATION OF COMPLIANCE FORM Lake Geneva Fire Department Fire Prevention Bureau 730 Marshall Street Lake Geneva, Wisconsin 53147 Business Phone: 262.248.6075 Fax: 262.248.2264
The compliance date listed on your fire inspection report identifies that date which the listed violations must be corrected. Please forward this form when the identified violations have been corrected. Should you need additional assistance regarding this matter or additional time in which to correct the listed violations, please contact the Fire Prevention Bureau at the above number. Thank you for your cooperation in making Lake Geneva a fire safe community.
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Correct violations and return by - - Please check the appropriate statement below and fax or mail the completed forms to the above listed address. All violations have been corrected Additional assistance required
Signature of owner or agent verifying corrections _____________________________________________ Please print name _____________________________________________ Date ____/____/________
NOTE: RANDOM ONSITE INSPECTIONS MAY BE DONE TO VERIFY COMPLIANCE FAILURE TO COMPLY AND RETURN THIS SHEET BY THE COMPLIANCE DATE MAY RESULT IN ADDITIONAL INSPECTIONS AND A $500.00 FINE