Violation Complaint FormVCM
1. Property Address
City Assessor’s Parcel # _________-_________-_________ Zoning Parcel Size Property Owner’s Name Phone # Owner’s Mailing Address
2. Nature of the Complaint (Check Box(es) and describe)
�Violation No. ________________________
Zoning Code Violation(s)
�Violation No. ________________________
Health Code Violation(s)
�Violation No. ________________________
Building Code Violation(s)
��HAZ/SUBCWOP
�Grading / Fill without Permit(s) Violation No. ________________________ � CODE ENFORCEMENT STAFF USE ONLY BELOW THIS LINE �
3. Report of Investigation
�Letter _____________ �Letter _____________ �
Letter _____________
�Recorded Other ____________________________________________________________________
Priority ______ �Permit # _____________ Date Violation Closed ______________
Sonoma County Permit and Resource Management Department
2550 Ventura Avenue � 95403-2829 � Fax (707) 565-1103
Santa Rosa, CA � (707) 565-1900 �
dpw S:Handouts\CDE\CDE-001.cdr rev: 6/17/2008 __________________________ _________________________________ __________________________ ___________________________________________ ___________________________________________ ___________________________________________ ���������� ����
Code Enforcement Report of Investigation
CDE-001
Date of Inspection Inspector Violation # �Rental �Owner Occupied �
�Administrative Design Review Approximate Quantity Observed Septic
Plumbing Repair Permit
Substandard / Hazardous
�Site Plan Sketch
Structural Hazards
Hazardous Electrical Wiring
Hazardous Plumbing N
Hazardous Mechanical
dpw CDE-001.cdr 06/17/08
Improper Occupancy Referrals: |
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�Agriculture Commissioner |
�Project Review |
Priority Score: (1=Low 20=Highest) |
|
�Air Quality |
�Regional Water Quality Board |
_____ Threat to Public Safety (1-20) |
|
�Animal Control |
�Well & Septic |
_____ Effect on Other People/Properties (1-20) |
|
�Army Corps of Engineers |
�City: |
_____ No. of People/Properties Impacted (1-20) |
|
�Encroachment |
__________________________ |
_____ Number of Complaints (5-20) |
|
�Environmental Health |
�Other: |
_____ Economic Incentive (1-20) |
|
�Fish & Game |
__________________________ |
_____ Culpability of Violator (1-20) |
|
�County Dept. of Transportation |
_____ Total |