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Complaint Form

 * Required Fields
 
Address of Concern:
Number :
Apt # :
Street Name:
   
 
Description of location: (ie NE corner of; vacant lot to the right of)
 
What type of Concern do you have at the above referenced address ?
Inoperable/Junked Vehicle : City Code Sec 29-58 
Make: 
Model: 
 
Color: 
License No: 
 
Location of Vehicle:
Front Yard: 
Rear Yard: 
Side Yard: 
Driveway: 
On Street
Can the vehicle be seen from the street:
No
Yes
Is the vehicle license expired or missing:
No
Yes
Is the Inspection sticker expired or missing:
No
Yes
 How long has the vehicle been there: 
 Describe the condition of the vehicle: 
Accumulation of Solid Waste : City Code Sec 14.5-5 
Front Yard: 
Rear Yard: 
 
Near Curb: 
Vacant Lot: 
 
Description of Waste: 
Tall Weeds and Grass (Taller than 12 inches) : City Code Sec 27-2 
 
Front Yard: 
Back Yard: 
Vacant Lot: 
 
Recreational/Commercial Vehicles Parked in Residential Area : City Code 
Sec 25-293 
Make:  Model: 
Color: 
Location of Vehicle: Driveway:  Rear Yard:   
  Side Yard:  Front Yard:  Street: 
Description of Vehicle: 
How Long has the Vehicle been Located There: 
Parking on the Grass : City Code 
Sec 25-293-1 
Location of Vehicle: Front Yard:  Other:   
Time Violation Occurs: Daytime Hours:  Evening Hours:   
  Overnight:   
Description of Vehicle: 
Mosquito/Insect Breeding/Rodents : City Code Chapter 36 
Description of Breeding Situation: 
Location: 
Bulk Waste Refuse : City Code Chapter 41 
Improper Storage
Improper use of SPSA Container
 
 Overflow Garbage
Waste Container out on non-collection day
 
 Illegal Container Placement
Bulk Waste out on non-collection day
 
Description of issue: 
Existing Structure : City Code 25.2-7 
Type of Structure:
Single Family Home
Duplex
 
Apartment Building
Fence
 
Accessory Structure
 
Type of Concern:
Flaking & Peeling Paint
Roof in Disrepair
 
Gutters rusted or in Disrepair
Porch in Disrepair
 
General Exterior Disrepair
Open/Vacant
 
Detail Description of Concern: 
New Construction : City Code Chapter 11 
Working Without a Permit:
Yes
No
 
What Type of Work:
Mechanical
Electrical
 
Plumbing
Building
 
Description: 
Construction Site Maintenance: 
If your concern was not noted above please describe it below :
 
How could we avoid this violation occurring in the future?
Other comments
You do not have to leave your name but, it is important to us to make sure we have the correct information to effectively investigate your concern.
Name:
Address:
Phone:
E-Mail:
 

 
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810 Union Street, Norfolk, VA. 23510 757-664-4000