HomeMy WebLinkAboutGully Filled with Trash, Concrete and Bulk Vehicles - BLD Letters / Memos - 12/2/2005 INVESTIGATION REPORT FORM >
Revised 01/22/03
Part A: Nature of Complaint
• Initiator's Name:
• Address:
• Telephone:
• Owner Name:
• Address: -Po P-il))( t C1
• Telephone*-
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• qeparfment of Concern
I L] Clerical ❑ Building 112Q Health ❑ Comm Development ❑ Fire
• Area of Concern:
❑ Process Delay ❑ Personnel El Policy/Fee ode Violation ❑ Other
Refer wDixecto. VC
• Location o Concern:
100 � )E/ I A40AJ >
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• Site Address
• Nature ofiConcern:r -ah Twb chkiplu, 'r rv, A Ve-
• DOES COMPLAINTANT WANT TO REMAIN ANONYMOUS ❑ Yes ❑ No
Part B: Concern Intake and Referral
Received By: Referred To: Response Date:
Name Date Name Date Date
Part C: Findings
Referral Forwarded to: LIN/A
Name Date
Findings: vallA Ova& 6- 1z"+, At
Y'
Part D: Resolution
0 wNIS V eA 4An-2! Si, X P-0 L&'k1,oA
I,-- A
Name Date
Intake Copy-White File Copy-Yellow