HomeMy WebLinkAboutDrainage Culvert Filled - GRD Letters / Memos - 2/4/2008 INVESTIGATION REPORT FORM U v 0 3 a
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Revised 01/22/03 n
Part A: Nature of Complaint
• Initiator's Name:
• Address: O N
N
• Telephone:
C
• Owner Name:
• Address: �n
• Telephone:
• Department of Concern
❑ Clerical ❑ Building ❑ Health ❑ Comm Development ❑ Fire C
• Area of Concern: (;
❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other Q
Rehr to Director '
• LKation of Concern: /
A
• Site Address v z , eOLL w A
• Nature of Concern:
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• DOES COMPLAINTANT WANT TO REMAIN ANON7US ❑ Yes ❑ No
Part B: Concern Intake and Referral
c • ed By: Re ed To: Response Date:
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Name Date Name Date Date G�
Part C: Fin gs
Referral Forwarded to: �`- 6 6 N/A
YAW-
Name ` Date
Findings: f rl .Yz.. GpbaA�i
Part D: Resolution
Name Date
IMske Copy-Wh to M Copy-YeUow
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INVESTIGATION REPORT FORM o a u 3 n 9
Revised 01/22/03 n
171
Part A: Nature of Complaint
• Initiator's Name:
• Address:
• Telephone:
8 $ • Owner Name:
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T ? • Address: 07
l� Q • Telephone:
r t • Department of Concern
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f.s � ❑ Clerical Building ❑ Health ❑ Comm Development ❑ Fire
• Area of Concern:
❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation 6 Other ,
Refer to Director
.},�• Loc tion of Concern:
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ncern: J,,Ct , a K V b
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�• DOES COMPLAINTANT WANT TO REMAIN ANONYMOUS )�Yes ❑ No
Part B: Concern Intake and Referral
Received By: Referred To: Response Date:
�hov►E ' 4L r- 3/Z 9 /o 5— S �
Name Date Name Date Date 0
Part C: Findings y
Referral Forwarded to: ❑N/A
Name Date
Findings:
Part D: Resolution c1S -dV43J 'M 9ZV
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Name Date
Intake Copy-White File Copy-Yellow
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Kristin French
Senior Planner—Code
Enforcement
Phone:(360)427-9670 ext. 593 ( �� f� ��l�ljl���
Fax:(360)427-8425 �11�111
frenchkna co.mason.wa us
PO Box 279 Shelton,WA 98584
ENF NUMBER:
TAX PARCEL NUMBER:
ZONING DESIGNATION:
ADDRESS:
OWNER:
.........................0 0 0 00 0 0 0 0 0 0 0 0 0 0• • 0 0 9 9 0.........•.
VIOLATION(Description and citation to applicable ordinance):
STATUS VALID UNSURE INVALID
PRIORITY HIGH STANDARD LOW
DATE OF INSPECTION: g US
INSPECTOR: 16 L' i=
SITE EVALUATION NOTES/SKETCH OF SITE/MEASUREMENTS TAKEN:
',�w �� o�� w-..�� ..��.-..+�" ��Jam..•F/
CONTACT WITH OWNER/
OCCUPANT YES NO
CONTACT PHONE/ PHONE: ADDRESS:
ADDRESS
PHOTOGRAPHS TAKEN YES NO
STOP WORK ORDER
POSTED YES NO
***Please input digital photographs into the applicable ENF case. If a Stop Work Order is posted,
please retain photograph of posting and a copy of the Stop Work Order for file records—attach to
this field sheet and return to Kristin French***