Permit 724 Bonita Road CITY OF ATLANTIC BEACH
SPECIAL INVESTIGATION
TO BE FILLED OUT BY COMPLAINTANT
DATE ( 7 -
ADDRESS_ '� ,� �/ 6) Q ! T fl-
LOCATION S t9 tit
COMPLAINT CA k'_PC,, p( �-,��( � O S� � 17 r, i /2 in
t l j
OWNER OF PROPERTY
SIGNATURE OF COMPLAINTANT PHONE #
---------------------------------------------------------------------------------
FOR OFFICE USE ONLY
DATE OF INVESTIGATION '" 12,/ INVESTIGATOR
CONDITIONS FOUND
ACTION TAKEN SLC GJ(7 i-f 7 - ILI /9, to 7-
COMPLIANCE T r, /2 N ,D 70 (C2
7 /Q eLJ 11-( /� C ��} ll) /" `� /'l c✓_�%`
NOTES: