Norfolk CARES Service Request Form
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 investigate your concern effectively.
Name:
Address:
Phone:
E-Mail:
