Code Enforcement Service Request Form

CODE ENFORCEMENT SERVICE REQUEST FORM

- confidential -

Although anonymous requests are not accepted, all information regarding who submitted the complaint is kept confidential.

Please fill out this form completely. We cannot investigate unless you provide all the information requested below.

If your complaint has to do with vehicles parked on the street, please contact the Santa Maria Police Department abandoned vehicle hotline at (805) 928-3781 extension 2956.

1

Address of violation: (if no formal address is available, please provide a general description of area. i.e. 1000 block ABC Street)

 *

Address of violation: (if no formal address is available, please provide a general description of area. i.e. 1000 block ABC Street)

2

Date observed

 *

Date observed

3

Owner's/Occupant's Name (if known):

Owner's/Occupant's Name (if known):

4

Owner's/Occupant's Phone (if known):

ext.Owner's/Occupant's Phone (if known):

5

Owner's Address (if known) List Street, City, Zip Code:

Owner's Address (if known) List Street, City, Zip Code:

6

Nature/Description of Complaint:

 *

Nature/Description of Complaint:

7

Complainant (person filing complaint):

 *

Complainant (person filing complaint):

8

Complainant's Address (Street, City, Zip):

 *

Complainant's Address (Street, City, Zip):

9

Complainant's phone:

 *

Complainant's phone:ext.

10

Date of Complaint:

 *

Date of Complaint:

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

To prevent spam we utilize a verification code system. Please enter the code as it is shown in the box below:

 

Code:

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