HomeMy WebLinkAboutDrainage Culvert Filled - GRD Letters / Memos - 2/4/2008 INVESTIGATION REPORT FORM 00103 M
Revised 01/22/03
Part A: Nature of Complaint
• Initiator's Name:
• Address:
C' N
• Telephone:
C
• Owner Name:
• Address: •• V�
• Telephone: O�
• Department of Concern
Q Clerical ❑ Building ❑ Health Q Comm Development ❑ Fire
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• Area of Concern: (�
❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other
Refer to Director
• L ation of Con ern:
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• Site Address -;0 lA.)4- y i A
• Nature of Concern:
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• DOES COMPLAINTANT WANT TO REMAIN ANONYWUS ❑ Yes ❑ No
Part B: Concern Intake and Referral
Rc ' ed By: Ref red To: Response Date:
r .� /05 ro
Name Date Name Date Date
Part C:Fin gs s
Referral Forwarded to: fix— �'y UQ N/A
Name Date
Findings: Ar uJ 7, j v k;, G
Part D: Resolution
Name Date
Intake Copy-White File Copy-Yellow
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INVESTIGATION REPORT FORM o a u 3 n >
Revised 01/22/03 n
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Part A: Nature of Complaint
• Initiator's Name:
• Address:
8 • Telephone: )
• Owner Name: HdObr►'y)► kn livt J L��
T ? • Address: JLZ25
t )
,Q • Telephone:
t ��tJJ •Department of Concern
❑ Clerical Building ❑ Health ❑ Comm Development ❑ Fire
• Area of Concern:
❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation Other
1 1 Peter to Director
• Loc lion of Concern:
z
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r>y
Site Addre (O O S d
t
• Nature o Concern: � Ira K 1D
- DOI
O cTn Co - ,)O 1,10 v Sp
"Xi Or 1�4D
�7- DOES COMPLAINTANT WANT TO REMAIN ANONYMOUS )4Yes ❑ No
Part B: Concern Intake and Referral
Received By: Referred To: Response Date:
�h�✓� IGi r- 3
Name Date Name Date Date O
G)
Part C: Findings
Referral Forwarded to: ❑N/A
Name Date
Findings:
Part D: Resolution �1S 21t143J 'M 9Zt
07 2 7 �dW
1d
Name Date
Intake Copy-White File Copy-Yellow
Kristin French
Senior Planner—Code
Enforcement
Phone:(360)427-9670 ext.593 ( ��1�RJ�J ��4'PJ1R�l�l'J
Fax:(360)427-8425
frenchk cDco.mason.wa us
PO Box 279 Shelton,WA 98584
ENF NUMBER:
TAX PARCEL NUMBER:
ZONING DESIGNATION:
ADDRESS:
OWNER:
........................................... . .................
VIOLATION(Description and citation to applicable ordinance):
STATUS
VALID UNSUR - INVALID
PRIORITY HIGH STANDARD LOW
DATE OF INSPECTION: US
INSPECTOR: IG(- (--
SITE EVALUATION NOTES/SKETCH OF SITE/MEASUREMENTS TAKEN:
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***