80-82 HATHORNE STREET - VACANT HOUSE COMPLAINT a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET 4"FLOOR
KIMBERLEY DRISCOLL
MAYOR TEL.(978)741-1800
/
1 FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINId'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: ` '' Time: J ' Received By:
Complaint Number: 2160
Complainant _
Address: Phone:
Investigated By: _ - _Date:
Property Owner/Occupant Name - Telephone#: -