HomeMy WebLinkAboutLogging Near Wetlands, Culvert Installed without Permits - GRD Letters / Memos - 8/8/2006 ceu
INVESTIGATION REPORT FORM z
Revised 01/22/03
Part A: Nature of Complaint
Initiator's Name: MENEM
r
Address:
ss Telephone:
I p
elephorne:
0 Ownerr J�
wner Name: 0i-SC-y\
Address: (0 5 76 N Aee,�, C-voeV-- Dew cLfft 1QX
• Telephone:
• Department of Concern Lq
D Clerical ❑ Building ❑ Health ❑ Comm Development ❑ Fire
• Area of Concern:
0
❑ Process Delay Ll Personnel ❑ Policy/Fee ❑ Code Violation El Other
Refer to Director
• Location of Concern:
> 0
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• Site Address
• Nature of Concern: C VJ y
ko"SArA iU d I ts CL L QC: 42 ,LO ad'
• DOES COMPLAINTANT WANT TO REMAIN ANONYMOUS Ll Yes ❑ No
Part B: Concern Intake and Referral
Received By: Referred To: Response Date:
4.-
Name Date Name Date Date 0
Part C: Findings >
Referral Forwarded to: L)N/A
Name Date
Findings: j t&S- i 4e 1' a r 12e cho v,) Jo ri eM f
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to Q LU L-�h I)Y\ �Jvl 9- n:E 4-k ew me e T 4v\e
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Part D: Resolution
CA oa ca
Name Date
Intake COPY-White File Copy-Yellow