Lake Winds Energy Park Notification of Complaint Form

As of: 7:33 AM, 11/21/24

First Name Date of Notification Street Address State Phone Number

Last Name City Zipcode Email Address

Location where event/occurrence happened (if different from above):

Street Address State

City Zipcode

Description of event or occurrence

Date of occurrence Time of Occurrence

Duration of Occurrence Turbine Number (If known)

If known, briefly describe how you believe the event or occurrence violates the Mason County Zoning Ordinance and/or the Special Land Use Permit, such as shadow flicker, noise, etc.

By signing below, I attest that I am the owner or other resident of the property and hereby grant Consumers Energy and/or its agents or contractors permission to enter upon above described property for purpose of investigating the event or occurrence described above, after prior notification to me.

Signature ( Please type your name )