117 Lafayette Street Unit 215 Complaint 5-9-2019 oriwr��
k� l CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
_ KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4m FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDTNtSALEM.CO�
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2429
Complainant _
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Investigated By: Date:
Property Owner/Occupant Name_ Telephone #: