ALL QUESTIONS MARKED WITH AN ASTERISK (*) ARE REQUIRED.

1

COMPLAINT REFERRED BY:

 *

COMPLAINT REFERRED BY:

Public

County Department

Other Agency

2

 REPORTING PARTY INFORMATION (REQUIRED):

Complaints that include verifiable Reporting Party contact information will be prioritized by the Code Enforcement Division, and investigated according to the Board of Supervisors-directed priorities.

Anonymous complaints that do not demonstrate a direct nexus to life/safety issues and/or community quality of life may be closed without investigation.

ALL Reporting Party information is confidential, pursuant to all applicable laws and regulations, and is never released to either the subject of the complaint, or any member of the public requesting information as part of a Public Records Act request (PRA)

The benefits of providing your contact information include:

• Receiving the results of the investigation, if requested (Please Note that Code Enforcement will make every effort to provide the Reporting Party with a disposition following the investigation; however, this is provided as a courtesy only and is at the discretion of the Code Enforcement Division)
• Allowing the investigating officer to contact you in order to obtain additional details about the complaint (if required), as well as important safety information
• Receiving educational information about the Mendocino County Code of Ordinances (MCC) if the complaint is determined to be unfounded
• Receiving additional informational resources, if needed

REPORTING PARTY INFORMATION (REQUIRED): Complaints that include verifiable Reporting Party contact information will be prioritized by the Code Enforcement Division, and investigated according to the Board of Supervisors-directed priorities. Anonymous complaints that do not demonstrate a direct nexus to life/safety issues and/or community quality of life may be closed without investigation. ALL Reporting Party information is confidential, pursuant to all applicable laws and regulations, and is never released to either the subject of the complaint, or any member of the public requesting information as part of a Public Records Act request (PRA) The benefits of providing your contact information include: Receiving the results of the investigation, if requested (Please Note that Code Enforcement will make every effort to provide the Reporting Party with a disposition following the investigation; however, this is provided as a courtesy only and is at the discretion of the Code Enforcement Division) Allowing the investigating officer to contact you in order to obtain additional details about the complaint (if required), as well as important safety information Receiving educational information about the Mendocino County Code of Ordinances (MCC) if the complaint is determined to be unfounded Receiving additional informational resources, if needed

REPORTING PARTY NAME:

REPORTING PARTY PHONE NUMBER:ext.

REPORTING PARTY EMAIL:

REPORTING PARTY ADDRESS:

CITY:

ZIP:

REPORTING PARTY MAILING ADDRESS (IF DIFFERENT):

CITY:

ZIP:

REPORTING PARTY AGENCY/DEPARTMENT (IF APPLICABLE)

3

I WOULD LIKE TO BE INFORMED OF THE RESULTS OF THE INVESTIGATION:

Please Note that Code Enforcement will make every effort to provide the Reporting Party with a disposition following the investigation; however, this is provided as a courtesy only and is at the discretion of the Code Enforcement Division.

I WOULD LIKE TO BE INFORMED OF THE RESULTS OF THE INVESTIGATION: Please Note that Code Enforcement will make every effort to provide the Reporting Party with a disposition following the investigation; however, this is provided as a courtesy only and is at the discretion of the Code Enforcement Division.

Yes

No

4

IF "YES", PLEASE INFORM ME VIA:

IF "YES", PLEASE INFORM ME VIA:

Phone

Email

5

REPORTING PARTY DISCLAIMER:

 *

By checking this box I understand that if I choose to remain anonymous and/or fail to provide verifiable information my complaint will be reviewed by the Code Enforcement Manager, and at their discretion may be closed without investigation. I further understand that anonymous complaints that do not demonstrate a direct nexus to life/safety issues and/or community quality of life may be closed without investigation.

6

WHERE IS THE SUSPECTED VIOLATION?

In order for Code Enforcement to investigate potential violations, the subject property address and/or parcel number must be correct and accurate. Code Enforcement cannot investigate complaints where a general location and/or unspecified property is indicated.

If you do not know or are unsure of the exact address or APN, you can use the ZONING WEB MAP to pinpoint the location

WHERE IS THE SUSPECTED VIOLATION? In order for Code Enforcement to investigate potential violations, the subject property address and/or parcel number must be correct and accurate. Code Enforcement cannot investigate complaints where a general location and/or unspecified property is indicated. If you do not know or are unsure of the exact address or APN, you can use the ZONING WEB MAP to pinpoint the location

STREET ADDRESS:

CITY:

APN (IF KNOWN):

7

WHAT IS THE SUSPECTED VIOLATION? (multiple options may be selected)

Please note the following:

• If there is an IMMEDIATE DANGER TO LIFE SAFETY such as downed power lines, gas leaks or fire, call emergency services at 9-1-1
• Pursuant to California Health & Safety Code (HSC) § 17970.5, upon receiving a complaint from a tenant, resident, or occupant, or their agent, Code Enforcement will inspect a building or portion thereof intended for human occupancy that may be in violation of HSC § 17920.10 (Lead Hazards) and/or HSC § 17920.3 (Substandard Building) and subsequently provide a free, certified copy of the inspection report to all affected parties
• Complaints concerning the following will be referred to the appropriate agency. PLEASE NOTE that any such referrals will not be followed up by Code Enforcement. Please contact the relevant agency for any further information:
  • Criminal activity and/or potential threats to Code Enforcement Officer safety (Law Enforcement)
  • Septic issues, raw sewage on the ground, hazardous material spills, wells (Environmental Health)
  • Permitted cannabis sites (Mendocino Cannabis Department)
  • Water diversion, damage to water courses/streams (Dept of Fish and Wildlife/State Water Board)
  • Encroachments on the public right of way (Mendocino County Dept of Transportation and/or CalTrans)
  • Illegal dumping on the public right of way (Mendocino Solid Waste Management Authority)
  • Animal issues, such as noise, abuse, strays etc (Animal Control)
  • Commercial timber harvesting and conversions (CalFire)
  • Illegal burns/fires (Air Quality)

 *

WHAT IS THE SUSPECTED VIOLATION? (multiple options may be selected) Please note the following: If there is an IMMEDIATE DANGER TO LIFE SAFETY such as downed power lines, gas leaks or fire, call emergency services at 9-1-1 Pursuant to California Health & Safety Code (HSC) § 17970.5, upon receiving a complaint from a tenant, resident, or occupant, or their agent, Code Enforcement will inspect a building or portion thereof intended for human occupancy that may be in violation of HSC § 17920.10 (Lead Hazards) and/or HSC § 17920.3 (Substandard Building) and subsequently provide a free, certified copy of the inspection report to all affected parties Complaints concerning the following will be referred to the appropriate agency. PLEASE NOTE that any such referrals will not be followed up by Code Enforcement. Please contact the relevant agency for any further information: Criminal activity and/or potential threats to Code Enforcement Officer safety (Law Enforcement) Septic issues, raw sewage on the ground, hazardous material spills, wells (Environmental Health) Permitted cannabis sites (Mendocino Cannabis Department) Water diversion, damage to water courses/streams (Dept of Fish and Wildlife/State Water Board) Encroachments on the public right of way (Mendocino County Dept of Transportation and/or CalTrans) Illegal dumping on the public right of way (Mendocino Solid Waste Management Authority) Animal issues, such as noise, abuse, strays etc (Animal Control) Commercial timber harvesting and conversions (CalFire) Illegal burns/fires (Air Quality)

Dangerous/Substandard Building (Occupied)

Tenant or Agent for Tenant Reporting Substandard Housing per HSC 17920 and 17970

Illicit Discharge into Stormwater System

Environmental Degradation (e.g. grading, major vegetation removal in the Coastal Zone)

Development In The Coastal Zone

Active Non-Permitted Construction

Non-Permitted Cannabis Cultivation and/or Related Issues

Excessive Trash, Debris or Refuse

Storage of Non-Op Vehicles in Excess of Two (2)

Existing Non-Permitted Structure(s)

Occupied Travel Trailer(s) and or Excessive Storage of Travel Trailers

Violation in the Town of Mendocino

Other, Including Nuisances (Give a Brief Description) If other, type text here.

8

PLEASE DESCRIBE THE SUSPECTED VIOLATION IN DETAIL WITH SUPPORTING OBSERVATIONS:

Supporting observations should include the following wherever possible:

• date and time the suspected violation was observed
• time frames of when the suspected violation occurred
• who created and/or caused the suspected violation
• how the suspected violation was created and/or caused
• why the suspected violation was created and/or caused
• where on the property is the suspected violation
any supporting details that may be directly or indirectly related to the suspected violation

SUPPORTING OBSERVATIONS:

9

IF YOU ARE A TENANT OR AGENT FOR A TENANT REPORTING SUBSTANDARD HOUSING, IS AN INSPECTION REPORT BEING REQUESTED?

Inspection Reports can be requested for use in any possible civil matter arising from substandard housing issues.

Please note that Inspection Reports can ONLY be requested by the TENANT, or the AGENT FOR THE TENANT

 *

IF YOU ARE A TENANT OR AGENT FOR A TENANT REPORTING SUBSTANDARD HOUSING, IS AN INSPECTION REPORT BEING REQUESTED? Inspection Reports can be requested for use in any possible civil matter arising from substandard housing issues. Please note that Inspection Reports can ONLY be requested by the TENANT, or the AGENT FOR THE TENANT

Yes

No

N/A

10

WERE ANY EFFORTS MADE TO RESOLVE THE ISSUE OF SUSPECTED VIOLATIONS BEFORE SUBMITTING THIS COMPLAINT? 

WERE ANY EFFORTS MADE TO RESOLVE THE ISSUE OF SUSPECTED VIOLATIONS BEFORE SUBMITTING THIS COMPLAINT?

11

TO THE BEST OF YOUR KNOWLEDGE, ARE ANY OF THE FOLLOWING CONDITIONS PRESENT ON THE PROPERTY?

 *

TO THE BEST OF YOUR KNOWLEDGE, ARE ANY OF THE FOLLOWING CONDITIONS PRESENT ON THE PROPERTY?

Possession and/or discharge of weapons

Aggressive dogs or other animals

Recent or frequent presence of law enforcement personnel

Suspected criminal activity

Hostile/aggressive occupants

Other

No known Officer safety concerns

12

PLEASE DESCRIBE IN DETAIL THE SAFETY CONCERNS:

PLEASE DESCRIBE IN DETAIL THE SAFETY CONCERNS:

13

DO YOU KNOW WHO THE PROPERTY OWNER, TENANT, OR OCCUPANT IS? IF SO, PLEASE PROVIDE THE FOLLOWING INFORMATION:

DO YOU KNOW WHO THE PROPERTY OWNER, TENANT, OR OCCUPANT IS? IF SO, PLEASE PROVIDE THE FOLLOWING INFORMATION:

PROPERTY OWNER NAME:

PROPERTY OWNER PHONE NUMBER:ext.

PROPERTY OWNER ADDRESS (IF DIFFERENT):

TENANT/OCCUPANT NAME(S):

14

IS THERE ANY OTHER INFORMATION YOU FEEL WOULD BE RELEVANT TO THIS COMPLAINT?

IS THERE ANY OTHER INFORMATION YOU FEEL WOULD BE RELEVANT TO THIS COMPLAINT?

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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