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HomeMy WebLinkAboutOwner May Have Dug a New Pond Within the Last Year in a Wetland Buffer - BLD Letters / Memos - 9/22/2017 Case Number: Mason County Investigation Report Form Parcel Number.? 00 S(& violation Site Address: 4 0 Avg V, Property Owner(s):'G 44e A" q\( Phone#: Mailing Address: 1 C- �G�C 2 I ,Z�g '//AI 6VA �y fZ d Teaant/Contractor/Operator on site: Directions to Site: Description of Concern: It Oj2y- ZOO 6 � kj-2 CL4-,n n✓ CCU r C /L In JJ h hZ WQ+IC-►nr/1 . CV,0( 0940v � gecl j2k -1,12 1,041!1 jtb- (,c �14Arj YJA Under the provisions of the Public Disclosure Law, RCW 42.56.240, the complain cnzt may indicate a desire for disclosure or non-disclosure of their identity. 1f non-disclosure is chosen, this portion of this form will not be released to the public unless this case is filed in court. 1f filed,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): a 1�1(J��� MOO S Phone:( ) Address: s City stae zip Signature of Complainant Date: IDS SECTION FOR ALASON COUNTY USE ONLY Complaint Received by: 6VA S Date: � �Z 2 � � 7 Complaint Received by. ❑ Phone ❑Email ❑ Web Site In Person lti or,r) Department of Concern: ❑ Building a Planning_ ❑ Fire ❑ Public Works Environmental Health: ❑ Solid ❑ On-site ❑ Wells ❑ Food ❑ Other luvestigation Date and Findings: Date Closed: Reason Closed: Initials: © SECTIONIIS • DELIVERY cr _� ❑Ageni ❑Addressee • r a° . per^ Certified Mail Fee P ) (Printed Name) C. Date of Delivery 17- $ ,4- -S /Bar/7 m Extra Services&Fees(check box,add fee as apP dress different from item 1? ❑Yes O ❑Return Receipt(hardcopY) $ CC delivery address below: ❑No Return Receipt(electronic) $ +O Stmar J E3 ❑Certified Mail Restricted Delivery $ ` Here V C-3 [I,Adult Signature Required $ } 1� Adult Signature Restricted Delivery$ O Postage U$PSQ� -I- $ rq Total Postage an Fees ru S�G �- $ ❑Priority Mail Expre,-® -D SentToe2 _ _S� ❑Registered Mailm r-R J��� _ 1`----------- ------------------------------- ;tricted Delivery ❑Registered Mail Rest—. ' C3 fan pt.No.,or�'b�yfC No. Delivery -- ` \' -------------------------------------------- icted Delivery ❑Return Receipt for ------te--,ZI 4 ---s Merchandise Ci P+ Restricted Delivery ❑Signature Confirmationm ❑Signature Confirmation 7 Insured Mail Restricted Delivery Restricted Delivery (over$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No. G-10 9590 9402 1833 6104 2624 17 United States •Sender:Please print your name,address,and ZIP+40 in this box• Postal Service Mason County Community Services Dlppl*ppo 615 W.Alder Sheet ShOkA WA 96H i