49 ESSEX STREET - HOUSING COMPLAINT (2) =;+ .P CITY OF SALEM,MASSACHUSETTS
�.�, � BOARD OF HEALTH'�r
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDEJ,RS/REHS,CHO,CP-FS LRAMDINCR�SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: _
Complaint Number: 2411
Complainant
Address: t ` ' t= r ,n•• — '- I Phone: g
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Investigated By: ( Date: GA—L
Property Owner/Occupant Name Telephone#:
LA
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