PLACER COUNTY PLANNING DEPARTMENT

CODE ENFORCEMENT DIVISION

COMPLAINT FORM

Complainant=s Name: _______________________________________________________________

        Mailing Address: _______________________________________________________________

                                 _________________________________________Zip Code ______________

       Telephone:   Business______________________ Home______________________________

YOUR SIGNATURE ____________________________________________ Date_________________

Due to legal requirements only written, signed complaints can be investigated. Complaints will remain confidential unless legal action is taken which may require that the complainant be specifically identified. This report will assist the Code Enforcement Office in investigating your complaint. Complete and accurate information with photographs and/or additional documentation will assist in expediting this review. Complaints regarding activities/uses involving potential health or safety hazards will be given priority, all other complaints will be investigated in sequential order. 

TYPE OF COMPLAINT: _______________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

(Additional information and/or directional map may be included on the back of this form.)

Assessor Parcel Number ___________

Address of Violation __________________________________________________________________

Property Owner's Name _______________________________________________________________