HomeMy WebLinkAboutOTH Record Requests - 7/9/2003 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
it ,
would like to information: Requestor's Name
Mailed ` Faxed Picked Up Address Do 1�__
Date of Request 7 o City St Zi o�.o
Time of Request g ., q,6 n i(yL_, Phone Fax
PLEASE PROVIDE RECORDS FOR THE FOLLOWING:
Septic Records ❑ As-Built Only ❑ 12 Digit Tax Parcel No.
Other (See Below) _J > - -Z L D
Present Owner Legal Description
Previous Owner
Site Address
Ple se specifically describe what records or kinds of records you are requesting:
• RCW 42.17.020 1 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: Faxed ❑
Notes: Mailed ❑
To be picked up ❑