HomeMy WebLinkAboutPermit Septic Tank 1982-03-31v,;9lta.4/
s- 000192
SPRINGFIELD PUBTIC }IOR
/fri-'.,,,#{b
PW-127
Location of Compl
Type of Complaint
aint
' Address
?.&*ia * Ra;b-.,,Comp laintant's Name
Requested Action,
r'.dtH
hone'
-?.-rl
I
Action Taken 'Cir-cid-3/t"L): tl 'e cuq-.k o uf .Z/a f ', €o" idzntc..i T'S {o4p.!_
l-t <'*# oJor-.id4 ;-rr+*a ji er..^)tr,.- (j r,{rt-fr//k,*
To Be Completed J s/Name Date
rS tul'e t)[
31/Time A ,'o o
rdttEl
C.4qSq-d1 fltr.'-'r-
Po k sZ t-.r-*,-ow\
/enk )ry" ,/d' 9€-p*'c-
o( . rtl ",is c. </ '7-ar ff {-*
/^ *,f.- 7 /-.+f ,--.r 4,S
C-oa)(+<*F- rr' L4r ,Jt. "---
Standard Complaint Form'-_Sewer Problems :'
JOB NUI'IBER r ,, -ra
ADDRESS:ltiDlvlDUAL col'lP LAiNT DATA
RES II)ENT:Ptio;!E:
OI,INER :
-
PHONE:
tDDRL,SS:
41i tJ,zir #u,(o'Tu K d,
TYPE: R.,--Y f '
4- s7- trADATE NECE1VEDI
ZONE:
NATURE:
\f
("
COMPLAINTANT:
ADDRESS:
PHONE:
NOTIFIED:DATE
REFEIIRED TO:
)A t:ICE ANDFIND
a
\
.t-\,
REFE CITY AT'TORN
)P I A'MORNEY
PDND NG
,t\
( ;u ahAt/'*d )
?,),
\,:
FIN AL ACI'ION:! rHvnulD , ft neretmeL fl.rlolD , n RECIIECK INALED
P*(//fl-
I
NOTES:
)
f-4/- - <fio,-A/ fL4 fie n$o>-*,/ d,9+//,u . 't,(t, g*?. qf ./4tu
S-
SPRINGFIELD PUBLIC I.IORKS DEPARTMENT
Stqndql-d Complq1nllorm - Sewer Probl
PW-127
Time
Taken By
Location of Comp laint
Type of Comp laint
Complaintant's Name Addres s Phone
Requested Action
Referred To
Action Taken
To Be Oompleted BY
( date )
Name Date Time
Da te