HomeMy WebLinkAboutOTH Record Requests - 2/12/2007 MASON COUNTY PUBLIC RECORDS REQUEST FORM
426 W Cedar St, PO BOX 186, Shelton WA 98584
PHONE(360)427-9670 FAX(360)427-7798
Please allow 5 business days for us to respond to vour request*
items are being malled please allow an additional 3 days until you receive the paperwo*
would like to information: Requestor's Name
Mailed ❑ Faxed ❑ Picked Up ❑ Address
_ ) 7
Date of Request City St Zip
Time of Request _l' Phone $ /7_ 003 Fax
PLEASE PROVIDE RECORDS FOR THE FOLLOWING:
Septic Records ❑ As-Built Only ❑ 12 Digit Tax Parcel No.
Other (See Below) ❑ 2 3
Present Owner S W Legal Description
Previous Owner
Site Address
Please specifically describe what records or ki ds of records you are requesting:
ffi 14
• RCW 42.17.0201 certify that the information obtained through this request will not be used for
commercial purposes.
Signature Date
• Large requests may be charged as provided by RCW 42.17.310. During file review, any pages
you wish to have copied (excluding non-public record documents) must be tagged and charges
will be assessed at ,15 per page. Copies can be mailed or you may pick them up when ready.
• Copies of blue prints or other large format items, when available, may be charged a higher rate
er a e
Official Use Only
Request Routed To: PAC File Clerk ❑ County Admin. ❑ Clerk of the Comm. ❑
Other ❑ Building ❑ Planning ❑ Environmental Health ❑
Public Works Assessor El Auditor 0 Treasurer
Completed b : f
P Y r 4��L Ext Records were
Completed date: 3- v Faxed ❑
Notes: 0 S l le P LA v� w I'le S Mailed ❑
l ,-cam ' To be picked up 0