73 Harbor st rooming house releases 2023 CITY OF SALEM, MASSACHUSETTS
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120 WASHINGTON STREET;4"'FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR ix,.zxi NRl UM(@ ,vX-.Ni.CO.N1
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AcriNG HEuTH AGENT
release
In accordance with Massachusetts General Lars Chapter 111; Code of Massachusetts Regulations 41 0.000 et. Seq. ;
State Sanitary Code Chapter II and Article)(Ill of the City of Salem Ordinance,undersigned owner/lessor and
tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health or its authorized agents to
inspect we residence identified below in accordance with the aforementioned statutes,regulations and ordinances.
In the event it is necessary that said inspection be done in my/out absence. Uwe expressly authorized the same and for
my/our successors and assigns hereby release and discharge the City of Salem, Salem Beard of Health and its
authorized agents from any lose or injury sustained of whatever nature and description occasioned by my/out absence
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CITY OF SALEM, MASSACHUSETTS n
B('ART)OF NFAT'TN V
120 WASHINGTON STREET,4"�FL0()R. R
TEL. (978)741-1800 i
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR DGR141 NBAUM a ,vXM.00M
A V IU Gxrravls:- UA4 1Cz
ACTING H&-�LTH AGENT
Release
In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq.;
State Sanitary Code Chapter II and Article XIII of the City of Salem Ordinance,undersigned owner/lessor and
tenant/lessee of a unit of residential property,hereby authorize the Salem Board of Health or its authorized agents to
inspect the residence identified below in accordance with the aforementioned statutes,regulations and ordinances.
In the event it is necessary that said inspection be done in my/out.absence. I/we expressly authorized the same and for
my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its
authorized agents from any lose or injury sustained of whatever nature and description occasioned by mylout absence
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Address :Address
Address on unit to be inspected
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CITY OF SAL,EM. MASSACHUSETTS
120 WASHINGTON STREET,4n FLOOR
TEL. (978)741-1800
KIi4iBF..R.LEY DRISCOLL FAX(978)745-0343
MAYOR DQ1UJENRAUM X-
1U %I.M
lU"XVID l XU--N15-A&4 n-AS
ACTING HEALTH AGENT
Release
In accordance with.Massachusetts General Lars Chapter.111;Code of Massachusetts Regulations 410.000 et. Seq.
State Sanitary Code Chapter 11 and Article)all of the City of Salem Ordinance,undersigned owner/lessor and
tenant/lessee of a unit of residential property,hereby authorize the Salem Board of Health or its authorized agents to
inspect the residence identified below in accordance with the aforementioned statutes,regulations and ordinances.
In the event it is necessary,that said inspection be done in my/out absence. Uwe expressly authorized the same and for
my/our successors and assigns hereby release and discharge the City of Salem,Salem Board of Health and its
authorized agents from any lose or injury sustained of whatever nature and description occasioned by my/out absence
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