273 Complaint 2005 BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
Date: y`(//DC I Time: if 70 &,, I Map: Parcel:
Name of Complainant: 5g„,,.l
Address: YI) 5"/" s t p
Tel:33 51 s64 g
1 75-,1 2,-N I NATURE OF COMPLAINT:
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Location:
Owner:
Address: ITeI:
Taken by: k?'ti I Date of Inspection: v/� fay
tit, P CCf, , t INnPE�CTOR'3RE'O/RT:
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Action Taken i� %I' -,Lien apQiw
ITime:f-o;3o-1
A) 4,95
Inspector Signature
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