Violation Address or Parcel Number

Assessor's Parcel Number (APN) of the property with violation:

Street Address

City

Zip

Please provide a brief description of the location of the property if the address or the assessor's parcel number is unknown (i.e. cross streets, etc.):

If known, please provide the name of the responsible person(i.e. tenant, property owner, etc.):

Please provide a description of the violation (Be as specific and complete as possible):

The following personal contact information is for our records only, and is not released to responsible person(s). This information MUST be provided for any action to be initiated on this request.

Prefix:

Mr. Mrs. Ms.

First Name:*

Last Name:*

Your Address

Street Address*

City*

Zip*

Phone Number: *

Email Address:

Cell Phone: