House at Corner Complaint Record 2012 BOARD OF HEALTH GC -
CITY HALL yea,'
LSD
COMPLAINT RECORD DOo
Date: ✓0z6 72alz
Time: //. 5„2 qr_,
GEO:
Type:
Name of Complainant:
Address:
Tel:
NATURE OF COMPLAINT:
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Location:
Owner:
Address: Nn'J5F it 36k t ITel:
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IDate of Inspection: I Time:
Taken by:
INSPECTOR'S REPORT:
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Total#of Inspections:
Date of Final Inspection:
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Orders Issued?:
Notice of Compliance?:
Inspector Signature
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