HomeMy WebLinkAboutOTH Record Requests - 3/4/2013 t400N CotVr�
Public Health
Mays worldng for a S heskhi r Memo County
PO Box 1666,415 N 6 Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 Belfair:(360)275-4467 ext 400 ❖ Elma:(360)482-5269 ext 400
FAX (360)427-7787
INFORMAL
-REQUEST
/�FOR ENVIRONNMENTAL HEALTH RECORDS
Reque ed by: 1 ., /TSSQCl4 S Date: _D LO
Mail Pick-up i_- E-mail ❑ Fax Fax Number:
To:
Name: 2)1996 4�vSMi'
Mailing Address:_f ! An 2c, -7 5,�0
E-mail: 61�rnnv, 0 _ 10,C ±C,.Q-nr v
City: State WA, Zip: OK58q
Phone Number: ,:;�W - 42-1,1-Z99r7
Please copy the checked forms:
Z-1-pnsite septic system records
Parcel Number:4o?DD/ — IfI/- 9D�
Site Address: ya&V/
Other
Special Instructions: /
Completed by: Kll� Date Completed: `
This form is not an official Public Records Request. To submit an official Public Records
Request go to the Mason County web site to download the form at:
ittn;/i a atic.�o,ma�gn.wa.us/forms/commissioners/public records reguest.pol
Public Records Requests must be submitted to the appropriate department's Records Officer.
Updated:7/18/2011