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Building Department
Complaintanquiry Report "
Date:_O L G'23— 0 a Rec'd by: �� � Assessor's No.:
-�_ O \
Complaint Name• - -
Location
Address:
WP
Originator Name:
Street:
Village: State: tip:
• i
Telephone:D/E
Complaint 0 r
Description —D
Inquiry 0
Description:
For Office Use Only
Inspector's ' � •� �� �.
Action/Comments Date: '— �[J ' 2 Inspector. I
n, V\-�fA -- l
Follow-up
Action
Additional Info.Attached
Copy MwibLdon. White-Depamnent File
Yellow-Inspector
Pink-Inspector(Rem=to OITce.lfanager)