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�oQc�r co�ran+x �oa:s�r <br /> DATE: !o — / - �/r TAKEN BY: v/ � � <br /> DEPT. RECEIVING COMPLAINT �(J'y,p�,,.,i�.r PHONE: // L/8' <br /> COMPLAINANT'S NAME: ' <br /> COt�LAINANT'S ADDRESS: <br /> COMPLAINANT'S PHONE: <br /> VIOLATINC ADDRESS: l � � `9I 0-t1/�/e�Dn <br /> INITIAL INSPECTION: INSPECTOA: <br /> CODE VIOLATION: //J��A,�G�c-�'iJ/e.,� ../�t�c�l�r�� ii � i� ` <br /> OWNER OF PROPERTY: <br /> OWNFR'S ADDRESS: <br /> OWNER'S PHONE: <br /> PARCEL ZONED: <br /> REPERRED TO FOR ACTZON: DATE: <br /> BUII.DING OFFICIAL: ' <br /> PIRE HARSHAL: ' <br /> POLICE DEPT.: <br /> LEGAL DEPT.: <br /> CODE COMPLIANCE OFPICFB: <br /> HOUSINC CODE INSPECTOR: <br /> COPY TO HAYOR: <br /> CHIP OPPICE: <br /> 0211f <br />