HomeMy WebLinkAboutExtensive Remodel - BLD Letters / Memos - 9/5/1995 INVESTIGATION REPORT FORM � ���r✓ v
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Part A: Nature of Complaint
• Initiator's Name:
• Address:
• Telephone:
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• Owner Name: •� �
• Address: i Zak.51 • 00017.•
• Telephone:
• Department of Concern
❑ Clerical efBuilding ❑ Health ❑ Comm Development ❑ Fire
• Area of Concern:
❑ Process Delay ❑ Personnel ❑ Policy/Fee eCode Violation ❑ Other
Refer to Directdr
• Location of Concern:
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• Nature of Concern: nTe
Part B: Concern Intake and Referral
Received B : Referred To: Response Date:
•
Name Date Name Date Date
Part C: Findings
Referral Forwarded to: ❑N/A
Name Date,,..,-i
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Finding
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Part D: Resolution
a '
Date
Intake Copy-White File Copy-Yellow Referral Copy-Pink