Pleasant Hill, CA · Contra Costa County
Request for Accommodation Under the Americans with Disabilities Act
This form lets individuals request an accommodation for a City of Pleasant Hill program, service, activity, event, or facility.
What this form is
This form requests an accommodation for a City of Pleasant Hill program, service, activity, event, or facility; it excludes land-use accommodations involving zoning or building regulations. The requester provides contact details, the location and date the accommodation is needed, and a description of the requested accommodation, with any suggestions for providing it. The city says alternative filing methods are available if needed.
Who needs it
Individuals seeking an accommodation for a City of Pleasant Hill program, service, activity, event, or facility can submit this request.
How to submit it
Send the completed form to City Engineer Ananthan Kanagasundaram, 100 Gregory Lane, Pleasant Hill, CA 94523, or email [email protected]; phone and fax are also listed.
About notarization
This form is signed and dated without a notary; it lists no notarized or sworn attachment, so the requester just signs and dates it.
How to submit this form
- 1
Download The Form
Download the City of Pleasant Hill Request for Accommodation under the Americans with Disabilities Act.
- 2
Complete The Request
Provide the requester’s contact details, the facility or activity location, the date needed, and a description of the accommodation.
- 3
Sign And Date
Sign and date the form. The document lists no notarized or sworn attachment.
- 4
Send To The City
Send the form to City Engineer Ananthan Kanagasundaram at the address or email listed on the form.
Frequently asked questions
- What does the Pleasant Hill ADA accommodation request form cover?
- It requests an accommodation for a city program, service, activity, event, or facility. The form excludes land-use accommodations involving zoning and building regulations.
- What information does the ADA accommodation request ask for?
- The form asks for contact details, the location and date the accommodation is needed, and a description of the requested accommodation, including suggestions for providing it.
- How do I submit the ADA accommodation request?
- Send the completed form to City Engineer Ananthan Kanagasundaram at 100 Gregory Lane, Pleasant Hill, CA 94523, or email [email protected]. The form also lists a phone and fax number.
- Do I need a notary for the ADA accommodation request?
- No. This form has a signature and date line but no notary block, and it lists no notarized or sworn attachment; the requester just signs and dates it.
Need something notarized?
This Request for Accommodation Under the Americans with Disabilities Act doesn’t need a notary — but if you have another Pleasant Hill form that does, a commissioned online notary can help.