HomeMy WebLinkAboutOuthouse Next Door - BLD Letters / Memos - 4/11/1996 (2� INVESTIGATION REPORT FORM _ tTj a
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Revised 10/6/94 W,a �
Part A. Nature of Complaint
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• Initiator's Name:
• Address: WES
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• Telephone: B-101
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• Owner Name:
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• Address: (s a n�:'
• Telephone:
• Department of Concern
❑ Clerical ❑ Building Health ❑ Comm Development ❑ Fire 14
• Area of Concern: T�
❑ Process Delay ❑ Personnel ❑ Policy/Fee Code Violation ❑ Other
Refer to Director c
• Location of Concern:
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9 Nature of Concern:
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Part B: Concern Intake and Referral
Received By: Referred To: Response Date:
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Name Date Name Date Date
Part C: Findings r
Referral Forwarded to: �G1mt. L7�1 t r�{-4 t I ' !Cf ❑N/A
Name Date
Findings: l�u71 i r< c, p l iz c4 L;, t*� C.G ! r� : 3 ? - n
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Part D: R olu 'o
Name Date
Intake Copy-White File Copy-Yellow Referral Copy-Pink