HomeMy WebLinkAboutCutting Trees and Clearing Site - GRD Letters / Memos - 3/21/2012 Case Number: 1:-Aj. D,. .)-
` Mason County Investigation Report Form
Parcel Number: '321 31 - rt 0n .6 6 6
Violation Site Address: 1 ZSZ c 1 V -asey 1w ke
Property Owner(s): E�Tcc S�e �'°u(� Phone#:
Mailing Address:
Tenant/Contractor/Opeerrator2on, site:
Directions to Site: J J � (mil- G(�
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r
Description of-Concern:
L Lt 1
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, the bottom portion of
this form will not be released to the public unless this case is filed in court. Iffiled,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 C ck 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): _ _ Phone:
Address:
Street City State Zip
Signature of Complainant: Date:
T SECP N FOR NA ON COOUUN_TY^USE ONLY
Complaint Received by(if applit;able) �J`t 1
Complaint Received by:',-, Phone Email Web Site. In Person
Department of Concern_ Building`_ Planning ' ;Fire Public Works,
Environmental Health Solid_. On-site Wells Food Other
Investigation Date and Futdi>3gs:
Date Closed: Reason Closed:- Initials: