36 BELLEVIEW AVENUE - TRASH, RODENT COMPLAINT 1 i
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4�'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDI.1,RS/REHS,CHO,CP-FS LRAMDINta'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: !a ' Time: Received By:
Complaint Number: 1784
Complainant }
f� /t' �� � Phone:
V
Address: .
jz
' r-�I.LNl j
J- 11-74
L I
Investigated By: Date:
Property Owner/Occupant Name Telephone #:
7�,