HomeMy WebLinkAboutOTH Record Requests - 9/9/2004 SEP-09-200Q(THU) 1Q: 21 HCTC (FRX)360 127 7179 P. 001 /001
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426 W cedar St,PO BOAC 1M,Shelbon WA 88584
PHONE(M)427-8870 FAX(860)427 7ta8
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I would fike.the i t on: Requestor's Nam / . A If
Malted ❑ axed PEcked Up ❑' Address
Date of Request 9_1j) City /1 St _ ZIP
Time of Request Phon Fait
PLEASE PROVIDE RECORDS FORTHE FOLLOWING:
Septic Records T 2t-C
Se
p ❑ As•-Built Only' ❑ ;`1`2 Digit Tax Parcel No.
Other(See Below} 1A 0— L - f— - q
31 0
Present Owner /I Ln Dp
Previous Owner. U Y1�dj N ry_-�
Site Address q50 � h l � 6
Please 'specifically describe what records or 'rids of records you•sre requestlrtg:
Zglp `e�k J16N
ti- .RCW 4:: 17.020 I cortlfythatthe Information obtained through this request will not be used'fbr
"commerriat;pu es. Q
Signature _ Date 1 ��
• Large requests may be:;charged as pruv4ed by RCW 42.17.310. During file review, any pages
you wish to have.copied (excluding non-pubilc r6cord documents) must be,tagged and.charges
will be az ed•at-15 per page. Copies can be mailsd'oryou may pick them up when ready.
• Copies as of blueprints or other large format Items, when available, maybe charged a higher rate
per a e
'Offlclal.Use Onl
Request Routed To: PAC Flle Clerk ❑. CountyAdmin- ❑ a0rk of the Comm. ❑
Other ❑, Building ❑ Planning ❑ Environmental Hoalth ❑
Public aloft Assessor . Auditor . Truasurar
Completed by. 11 -` Fes` �` I R®cords were
Completed date: .. . : : Faxed
Notes,- _ Mailed
L c� r C4' To be picked up ❑