35 MARLBOROUGH ROAD - OVERGROWTH COMPLAINT a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4r"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINr&,SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: f' Received By:
Complaint Number: 1767
Complainant
Address: i -b,P',i, a
Phone: g g r 1
i
r
f{ r / / L ,
I
Ll 2
yd(n-
Investigated By: ofu op Date:
Property Owner/Occ ant Name I I x N ITV yn'i elephoft #:
J
DW
NQ-R) Q
Is
- L-J}IJs� �� n+ OrjZ