Request For Investigation - Planning Department (Independence, California) Page 3
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REQUEST FOR INVESTIGATION
ZV #________________
(DO NOT ALLOW THE PUBLIC TO VIEW THIS DOCUMENT)
This form is to be utilized when a citizen is requesting that Planning Department investigate a possible zoning
violation.
This form is intended to remain confidential. However, the form must be released if required by law.
COMPLAINANT INFORMATION
(person completing this form)
______________________________________
_____________________________________
Name
E‐Mail
______________________________________
_____________________________________
Mailing Address, City/State/Zip
Phone Number
Do you wish to be contacted with the results of this investigation? Yes No
Would you consider mediation between you and the property owner where the alleged problem exists?
Yes No
I certify that the information provided on this form is true and correct to the best of my knowledge.
______________________________________
Signature
___________________
Date
DESCRIPTION OF VIOLATION / PROBLEM
Street Address of Violation
Community
Assessor Parcel Number (if known)
Property Owner (if known)
Nature of violation or problem (please be as specific as possible). Use the back of this sheet, if needed.
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