HomeMy WebLinkAboutNumerous Shoreline Violations - PLN General - 8/13/1996 INVESTIGATION REPORT FORM z
Revised 10/6/94 r)
Part A: Nature of Complaint
• Initiator's Name:
• Address: 1� W
• Telephone: N
• Owner Name: Vavr
• Address:
• Telephone:
• Department of Concern
❑ Clerical ❑ Building ❑ Health CI Comm Development ❑ Fire
• Area of Concern: / O
❑ Process Delay ❑ Personnel ❑ Policy/Fee �7 Code Violation ❑ Other Q
Refer to Director
• Location of Concern:
V
• Nature of Concern: // A101"Mas S,ore •,c ✓#01eJFo�c : al Wr
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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 -Y
Referral Forwarded to: ❑N/A �3
Name Date
Findings:
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Part D: Resolution r`t
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Name Date -n 9
Intake Copy-White File Copy-Yellow Referral Copy-Pink