13 BOW STREET - OVERGROWTH & RODENT COMPLAINT r k CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR (978)741-1800 FAX
FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMD[NOSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: /,�(,>/ '� Time: Received By: ,
Complaint Number: 2174 I
Complainant
Address: `K�1 fi% ��.�t��� Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone#: