211Complaint (2) . n BOARD OF HEALTH
' CITY HALL
��� COMPLAINT RECORD j 1 �V
Date: ^ 'ii loci Time: I Map: Parcel:
Name of Complainant: Lnc& ., HaccbriTnc.`[.
Address: -Z ■Z VN•r'i n Skeet— Tel:
NATURE OF COMPLAINT:
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Location:
Owner:
Address: Tel:
Taken by:A I Date of Inspection: Time:
INSPECTOR'S REPORT:
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Action Take
Inspector Signature O