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HomeMy WebLinkAboutRecords Request - OTH Record Requests - 4/16/2007 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 your request* `if items are being mailed please allow an additional 3 days until you receive the paperwork I would like the information: Requestor's Name -e(,(,I S Mailed ❑ Faxed ❑ Picked Up ❑ Address Date of Request —I C-7 City bdj "4 ! St Zip �p Cj )S %11Time of Request 10A YY\ Phone �(� ����� Fax PLEASE PROVIDE RECORDS FOR THE FOLLOWING: Septic Records ❑ As-Built Only ❑ 12 Digit Tax Parcel No. Other (See Below) 3 D -S 2 - © 2� Present Owner Legal Description Previous Owner Site Address �� ���f I t�-�Pise4J Please specifically describe what records r kinds of records you are requesting: (oi sl4� w • RCW 42.17.020 I 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 ❑ Auditor ❑ Treasurer ❑ Completed by: Ext Records were Completed date: — -07 Faxed 2 Notes: PAC M ef— ,.s ) cn, �q Mailed ❑ Vol<<,L�� ,',-A f To be picked up ❑