Code Violation Complaint Form

City of Pine Lake Police Department 456 Pine Lake Drive / P.O. Box 1325 Pine Lake, Georgia 30072 Phone: (404) 292-4250 / Fax: (404) 292-7531

Email: [email protected]

Complaint Information OPTIONAL INFORMATION (You may remain anonymous) Requestor’s Name: Address: Telephone Number: Required Information: Alleged Violation’s Name or Business Violation Date: ______/______/______ Time: _____________

AM

PM

Problem(s) / Violation(s):

Sign by Date ________/________/_________

Official Police Department Business This form will be forwarded to our License Code Enforcement Officer assigned to that area. He will respond to all Complaint Forms in order as they are turned in. Complaints will be investigated within (5) business days. Please provide your contact number and or email address if additional information is needed. To ensure that procedures are followed correctly, allow the PL Police department to handle your request immediately without taken matters into your own hands. For more information, or to speak with an Officer, contact Code Enforcement at (404) 292-4250, Fax (404) 292-7531 or email at: [email protected]