HomeMy WebLinkAboutJunk Cars and Wood Waste Debris - BLD Inspections - 11/2/2007 INVESTIGATION REPORT FORM y
Revised 01/22/03 iE+ c-2-ory��— oo2�9
Part A: Nature of Complaint
• Initiator's Name:
• Address: /O
N
• Telephone:
• Owner Name:
• Address:
• Telephone: 19
•Department of Concern vV
❑ Clerical ❑ Building Health ❑ Comm Development ❑ Fire N
• Area of Concern:
❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other
Refer to Director O
• Location of Concern: W
C
• Site Address Z50 E T►�-��,t aLes p�2 . --Q
O
• Nature of Concern:
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• DOES COMPLAINTANT WANT TO REMAIN ANONYMOUS . Yes ❑ No
Part B: Concern Intake and Referral
Received By: Referred To: Response Date:
CA�k 2-21 .°b
Name Date Name Date Date
Part C: Findings y
Referral Forwarded to: ❑N/A
Nam Date
Findings: C
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Part D: Resoluti
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Name
Intake Copy-White File Copy-Yellow