Rental Housing Inspection Program Form

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CITY OF SACRAMENTO 
RENTAL HOUSING INSPECTION PROGRAM 
TENANT CONSENT TO INSPECT RENTAL HOUSING UNITS 
PROPERTY ADDRESS: _______________________________________________ 
The  property  above  will  be  inspected  by  the  City  of  Sacramento’s  Rental  Housing 
Inspection Program to determine whether it complies with local and state regulations.  The 
inspection is scheduled for the following date and time: 
DATE: _______________ 
TIME:  _______________ 
As a tenant, you have a basic right to privacy and may deny the City permission to enter. 
You  may  be  present  during  the  inspection.  If  you  will  not  be  present  at  the  time  of  the 
inspection, the City requests that you consent to the inspection in your absence.  To give 
your consent, please complete the form below. 
CONSENTING  TENANT(S) 
I,  the  undersigned  am  a  legal  tenant  of  and  have  lawful  access  or  control  of  the  rental 
housing unit described below.  I the tenant, freely and voluntarily give my consent to have 
the  inspectors  of  the  City  of  Sacramento’s  Rental  Housing  Inspection  Program enter  and 
inspect the unit in my absence. 
Unit #:__________ 
Tenant Name:_________________________  Telephone: _____________________ 
Tenant Signature: _____________________  Date: __________________________ 
Unit #:__________ 
Name:___________________________ 
Telephone: _____________________ 
Signature: _______________________ 
Date: __________________________ 
Unit #:__________ 
Name:___________________________ 
Telephone: _____________________ 
Signature: _______________________ 
Date: __________________________ 
Unit #:__________ 
Name:___________________________ 
Telephone: _____________________ 
Signature: _______________________ 
Date: __________________________
Rev. 2/07/2012 

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