HomeMy WebLinkAboutDemo and Ground Prep - BLD Letters / Memos - 8/30/2018 Mason County Investigation Report Form
Case Number: 0 'n0�011 Parcel Number:
Violation Site Address: %l0 1� 1 r "N- k- ALItiN
Property Owner(s): Nv Nit ►.Aa
Mailing Address: eo I"1 LI—
Tenant/Contractor/Operator on site: Co�CQ�CtOR
Complaint Received by: Phone Email Website In Person
Directions to Site:
Description of Concern: \No -,& \j,3 � t��;� �, �10 arm
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Department of Concern: Building .\ Planning_ Fire Public Works
Solid Waste Onsite Wells Food Other
Investigation Date and Findings:
Under Chapter 42.56 RCW,the Public Records Act,a Complaint Form is a public record subject to disclosure. You,as a
complainant,may request that your identity not be disclosed to the public.If you request that the Community Services
Department not disclose your identity,the department will attempt to honor your preference,but makes no assurances
that your identity will not be made public.Additionally,if the complaint results in a case being filed in court,you will most
likely be named a witness and your identity will therefore be disclosed.
Mason County investigates possible violations on a complaint basis only. Therefore,the name of the person
filing the complaint should be provided.
Please Check One of the Following Lines:
Please do not disclose my identity. I understand that disclosure may be required by court
order or if this matter goes to court.
❑ You may disclose my identity.
Name(please print): :�C—)1-It.J Phone:
Address:
Street City State Zip
Signature of Complainant: Date: