HomeMy WebLinkAboutATKINS BLK 2 LT 5AT IdS
LOT-
:at~ Inv~stfgated:.,~
ction Taken:
REPORT OF ACTION TAKEN
~E COMPLAINANT WAS CALLED REGARDING DISPOSITION OF COMPLAINT:
/NUISANCE COMPLAINT FORM
.Complainant, s Name
Street Address:
Phone No~:~'-f~ Box
.~scPiption of Complaint:
Name of Person A~ainst Whom Complaint is Made:
Owner of Property Where Nuisance Exists: ~--*:~'~f/,~.~/~Z~/~r--
Owner's Address:
Location of Complaint:
Phone No,
Street Address: ~ ~
Person Receiving Complaint: /'~ ~-/c/~2~-/j/ ~-- d'--f Date: //--/~ ~_~
I certify that such statement of facts is true to the best of my belief and know-
ledge, I request that the foregoing matter be investigated and that appropriate
action thereafter be taken, I am willing to testify to the facts stated in the
foregoing complaint in court if necessary,
Complainant
IN THE GREATER ANCHORAGEMAMRi; B~O/, ALAS-
KA DID THEN AND THERE CO~ ENSE:
SECTION 21-2C THEOUTDOOR OR ~
ABANDOMENT OF ANY JUNK AS DEFINED II 21-8B
SECTIONoF PROPERTY21'8C NOXIOUS, IN~ARDOUS USE O
,ECTION 9.67 ,EWAGE D] ;) ~'~ [~
SECTION S-S8 WATER ~ O
SECTION ~-~! HEALTH & ALASKA ADMINI$*
TRATIVE CODE.
OTHER VIOLATIOF O
I HSR Y~-~.......~R~ECT THE ABOVE MENTION VIOLATION
WI~~ DAYS ,ROM THI$ DATE.
IT I$ UNDERSTOOD LEGAL ACTION WILL FOLLOW IF COMPLI-
ANCE I$ NOT MET.
THE UNDE SIGNED STATES THAT HE HAS jUST AND REA-
SONABLE GROUNDS TO BELIEVE AND DOES BELIEVE THAT
THE P~i~ON NAMED ABOVE COMMITTED THE OFFENSE
O~ICE~ ~GNATURE
HEALTH DEPAET~ENT
THE UNDERSIGneD, BEING DULY SWORN, UPON HIS OATH DEPOSES & SAYS:/ ~
ON ~ THE .i DAY OF 19~ AT . . ~
NAME
LAST
STREET ADD.
CITY __
STATE
MIDDLE
IN THE GREATER ANCHORAGE ARE~/~O~GH, STATE Of ALAS-
KA DID THEN AND THERE COMM fOl~ lNG OFFENSE:
SECTION 9-67 SEWAGE~
SECTION 9-2! ALASKA ADMINIS.
TRATIVE CODE.
SOLID WASTefUL "~__
OTHER VIOL
LOCATION oF~
WITH I~ ..... '~ "~-~. VIOLATION
%_ DAYS FROM THIS DATE.
it IS UNDERSTOOD LEGAL ACTION WILL FOLLOW IF COMPLI-
ANCE IS NOT MET.
VIOLATOR'S SIGNATURE
THE UNDERSIGNED STATES THAT HE HAS JUST AND REA-
SONABLE GROUNDS TO BELIEVE AND DOES BELIEVE THAT
THE PERSON NAMED ABOVE COMMITTED THE OFFENSE
HEREIN SET FORTH. CONTRARY TO LAW.
Z
OFFICER'S SIGNATURE