HomeMy WebLinkAboutZoning - BLD Letters / Memos - 10/20/2014 Case Number:
Mason County Investigation Report Form
Parcel Number. 1222 1 - <J - 0 05 0 n
Violation Site Address: 80 (' �/jftt5'3nK, Ltr) , ekV5" 2.�,�J
I?.
Property Owner(s): C K V-0.� �n Phone#:
Mailing Address: 80 E ("ICJSU Vt, LrJ, 6&Q 7atom q DS 2-0
Tenant/Contractor/Operator on site:
Directions to Site: Hw 302 0 V i C-W lL Qd. ,t2j+C rJ V,C-W 2, Lqt 0 n C4,, tt. ry -ovt.
r
21
Description of Concern: 2-0 PK/hA D W
u1, 11 - Pi V' 0,42 bU_A,I+_ CLA00 Cc 2
CO nCprPi► d. if -tv y C -to i N 4L� LL
Under the provisions of the Public Disclosure Law, RCW 42.56.240, the complainant may indicate a desire
for disclosure or non-disclosure of their identity. If non-disclosure is chosen, this portion of this form will
not be released to the public unless this case is filed in count. Iffzled,your name will be disclosed if you are
a witness in the case.
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:
❑ 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): fq Phone:
Address:
sum City S= zip
Signature of Complainant Date:
THIS SEMON FOR NL4SON COUNU Y USE ONLY
Complaint Received by: Date:
Complaint Received by. 2Kfhone I ❑ Email ❑ Web Site ❑ In Person
Department of Concern: ❑Building Tanning ❑ Fire ❑ Public Works
Environmental Health: ❑ Solid ❑ On-site Wells ❑ Food ❑ Other
Investigation Daze and Findings:
Date Closed. 7Reason Closed (i_`-; 6LL/O, G�_, Initials.