PERKINS STREET - OVERGROWTH & TRASH COMPLAINT ntttlT;'j
a CITY OF SALEM,MASSACHUSETTS
F BOARD OF HEALTH
,�,
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINk1�SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2164
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name _ Telephone#: