16 Cloutman Street Complaint 4-18-2018 �'nWtA
2s �
yr, CITY OF SALEM, MASSACHUSETTS
`��y. BOARD OF HEALTH
KTMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2089
Complainant f t
� n
Address: Phone:
42
r
Investigated By: Date:
Property Owner/Occupant Name Telephone #: