47 Larchmont Road Complaint 9-16-2019 u�
"� ^y, r CITY OF SALEM,MASSACHUSETTS
r- BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
r` MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINfu1SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: L1 Time: Received By:
Complaint Number: 2575
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Complainant 4
Address: F—r A Phone:
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Investigated By: Date: _
Property Owner/Occupant Name Telephone #: ___