HomeMy WebLinkAboutMFG Home without Permits - BLD Letters / Memos - 2/5/2004 �N F adb3-oU 15 U
INVESTIGATI PORT FORM
Revised 01/22/03 n
Part A: Nature of Complaint __
• Initiator's Name: I+ ID/t I W D uS
• Address:
• Telephone: {
M o lso✓I• Owner Name:
• Address:
• Telephone: - O
• Department of Concern 8
❑ Clerical Building ❑ Health ❑ Comm Development ❑ Fire G
• Area of Concern: ��EL A jdA1255 — p1 LQ ( E c0 I I I nS l- 0 rl o��—
❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other
I Refer to Director
• Location of Concern:
i V LO 5 L C Y►1 -e �'� z
&C) 0-TV,Lkd L6-yt Po s4 Gornrriun," �� Lam+
ii r�
• Site Address M t 5 L,V t� 1`0 4 tt tj 2 r
• Nature of Concern: u
n , V10 /r ,'f- . t'? w
Izo-4 Por d -}+r Lk tAL C ,j u✓t le- r
i n 1]!,:! 17/12 Lv
• DOES COMPLAINTANT WANT TO REMAIN ANONYMOUS ❑ Yes ❑ No
Part B: Concern Intake and Referral
Received By: ll q Referred To: Response Date:
ICU L1�
Name Date Name Date Date O
O
Part C: Findings
Referral Forwarded to: ❑N/A
Name Date
Findings:
Part D: Resolution
Name Date
Intake Copy-White File Copy-Yellow