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COMPLAIN NVESTICATION FORM <br />Date Complaint Received 7vee % / 3, 197y <br />Received From <br />Address <br />Tele No. <br />NATURE OF COMPUJ NT <br />A"0 Al AODVS <br />Pc o4/F 9 ,— /fb/ /" /i(,:/ f A L_ <br />&-Ic /C <br />Date of Inspection J0 K/= /y—l l? y <br />VIOLATIONS NOTED <br />�¢ l t c✓ f1 rn Y9 /1 �2fS OA( AAf 4_ C!f <br />Owner/Tenant Name <br />clpAddress _ i ri C, ` tcclaw <br />ACTION TAKEN <br />S,E 4 A /9 6. • i Li 112 <br />C//.-,/)/y/NG 7LI-.5 i44ES1Y1'c( <br />S (a = ( E, v G !J Tj .G/ s-//_=i' //c' S /> iY /vp <br />REMARKS <br />Follow-up date <br />, ed�, <br />Inspectors Signature <br />