HomeMy WebLinkAboutGully Filled with Piled Trees, Plywood and Garbage - BLD Letters / Memos - 11/22/2005 INVESTIGATION REPORT FORM E F'``'D 0 S n y
Revised 01/22/03 Vo 2 5 n
Part A: Nature of Complaint
• Initiator's Name:
• Address: N
UJ
N'
• Telephone:
• Owner Name: L L 0`I Tp PA--ra l C 1 A B N C �
• Address: B0 X 17 0 / IR FLEA-(12. laf A g8S2.� N
• Telephone: N
• Department of Concern C
❑ Clerical ❑ Building `� Health Comm Development ❑ Fire D
• Area of Concern: ///��� J
❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other
Refer to Diredor
• Location of Conce
I -ko Y14 o-r- :hLa.1,I ei�4 110 U rke z
• Site Address 100 TI M A )2 b R LLFA-!a
• Nature of Concern: (1/L4 - 36' GCVRX. i- 6' wide 19!1W jn ,,Y-
1
0�
• DOES COMPLAINTANT WANT TO REMAIN ANONYMOUS ❑ Yes ❑ No
Part B: Concern Intake and Referral
Received By: Referred To: Response Date:
Name Date Name (24w,3 ate Date 0
Part C: Findings I�
Referral Forwarded to: ❑N/A
1 a l(Q hOC Name _ Date
Findings: 4 W I iJ- t, C4- V fA4.4
(a ti f c ,
0- euv9cago,
Part D: Resolution
\ Name Date
I
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