1

Referred by:

Referred by:

County Department

Other Agency

Public

Note: In order for Code Enforcement to investigate potential violations, the subject property address and/or parcel number must be correct.

2

Subject Property Information

 

Subject Property Information

Property Owner Name:

Site Address of Violation:

City:

Mailing Address:

City:

Zip Code:

APN:

Owner Phone:ext.

Description of Complaint

PLEASE NOTE: Complaints which are determined by staff to potentially compromise or threaten the safety or security of a Code Enforcement Officer will be referred to the appropriate Law Enforcement agency.

3

Does this complaint concern substandard housing?

Does this complaint concern substandard housing?

Yes

No

4

If YES checked above, are you:

If YES checked above, are you:

Tenant

Agent For Tenant

Other (see below)

5

If OTHER checked above, please explain:

If OTHER checked above, please explain:

6

Is an Inspection Report being requested?* (For Tenants/Agents ONLY)

Is an Inspection Report being requested?* (For Tenants/Agents ONLY)

Yes

No

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

CONFIDENTIALITY: Every effort will be made to keep the complainants identity confidential within the limits of existing laws.

7

Would you like to be notified of the results of this complaint?

Would you like to be notified of the results of this complaint?

Yes

No

8

If yes, please choose the method you would like to be notified.

If yes, please choose the method you would like to be notified.

Phone

In Person

By Mail

Email

9

Please provide your contact information below to be notified of the results.

Please provide your contact information below to be notified of the results.

Date of Complaint:

Name:

Phone:ext.

Residence Address:

Mailing Address:

Email:

Please Note: You will receive an auto response that we have received your complaint. Complaints that constitute potential health and/or safety hazards will be given priority. All other complaints will be investigated as they are received.

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

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