HomeMy WebLinkAboutComplaint Form 2010-11-23 LOG IN DATE;
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BUILDING DEPARTMENT ASSIGNEDTO:
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573
(914) 939-0668 ASSIGNED BY:
COMPLAINT FORM
RECEIVED BY: � Lv
DATE: FOR OFFICE USE ONLY
LOCATION: lct
NEW S.B.L.: (� . J a" OLD S.B.L.: USE:
OWNER: O C
Address&Phone: ANis
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SOURCE: Phone/Letter/Other:
Address&Phone:
COMPLAINT: n 6 l V 40
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POSSIBLE VIOLATION:
INSPECTORS LOG
DATE STATUS INS TOR