HomeMy WebLinkAboutOTH Record Requests - 10/21/2005 MASON COUNTY PUBLIC RECORDS REQUEST FORM
426 W Cedar St, PO BOX 186, Shelton WA 98584
PHONE(360)427.9670 FAX (360)427-7798
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Time of Request 13 3 S Phone Fax
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PLEASE PROVIDE RECORDS FOR THE FOLLOWING:
Septic Records ( As-Built Only ❑ 12 Digit Tax Parcel No.
Other(See Below) ® z
Present Owner 6�14A po 14Ac.kl- Legal Description 1AEp I K
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Previous Owner
Site Address Sm 8ALBR
Please specifically describe what records or kinds of records you are requesting:.
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3� yRS A_flLro
• RCW 42.17.02 0 I certify that the Information obtained through this request will not be used for
comrnerciaJ purpose .
Signature Date
• Large requests maybe 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
per page
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: Faxed ❑
Notes: Mailed ❑
To be picked up ❑