103 HIGHLAND AVENUE - OVERGROWTH & TRASH COMPLAINT a
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(a�SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2179
Complainant
Address. Phone:
Investigated By: Date:
Property Owner/Occupant Name_ Telephone#: