14785 SW 104TH AVENUE 14785 SW 104TH AVEN..,
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NUISANCE OR HEALTH VIOLATION rolating to %� /'!
rremises described on the richt Is allegraSt eet or RFD b City
as follows:
A
Name of Occupant Telephone
�----- Name of Owner Te;ephone
Invest!gation �f this problem
�_•Iwas requested by the person whose
name appears In the space to the left.
Date request received In Health Dept: `
_ Taken by:
Telephone:
Problem found:^--------------------------------------------------------'a4:S---------------------------
:S-- - -
Action taken b closure:
Date Closed Signed
Sanitarian
')a'" Field Notes
s
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