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CO'rPLAINI IN!'ESTI 'AT10N FOF.%I <br />Date Complaint Received C, 'u- 2 1 97S <br />Received From <br />Address i�%(�UI•aL/%A/� Ilu� <br />Tele No. <br />NATUF:= OF CC','PLAINT "�� ta` 2 9cU <br />0 <br />Date of Inspection C%,�_1 1 �- 2 S <br />VIOLATIONS NOTED <br />�r7ytcT 440si .-I!S4x /"/S ,, I- IVL) CAy<ti r /'��YT2S <br />�WK.¢ auZrT /-Q0 tiL� Fr <br />4/1) LAy szg ick,4� <br />Owner/Tenant Name <br />Address <br />ACTIU TAKE`! <br />REV*k'S <br />Li/— /ie 1T /n.)i<n:.^- 4'7- /3Lb 11-1-7) 4zti <br />Follo%N-up date <br />if :�� ct6r i Signature <br />I <br />