HomeMy WebLinkAboutCleared Trees and Stumped - GRD Letters / Memos - 5/12/2017 Case Number: -zo r I 'd�
Mason County Investigation Report Form
Parcel Number. 2 Z 3) 0 -') ) - CJG II
Violation Site Address: 2I 1 � (6 Al-W l L- L-9 17C If4, r W,ll
Property Owner(s): RC h 4 1_�-(-r'LAS Phone#:
Mailing Address: F 6. F&g� 1�c<Z. , (/L),4 A ACD
Tenant/Contractor/Operator on site:
Directions to Site: LOA ' 3 1-6W AA _�F2MV y ►n ,LL
C-t�ekf' l ✓' Vt �L CJ �I�PP� 1,�ErlA�.tTO �f� �(C V
l
Description of Concern: r/e,.vea.L V-'E!-Q s �z�1 - v c�v
c
V\ Gn► V\
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 court. If 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): /7V)Ook f I)II40(i .S Phone: ( 1
Address:
Strut City State Zip
Signature of Complainant Date:
THIS SECTION FOR MASON COUNTY USE ONLY Y Z
Complaint Received by: n VV0 Date: - /A*/)
Complaint Received by: C"Phone ❑ Email ❑ Web Site ❑ In Person
Department of Concern: ❑ Building Manning- ❑ Fire ❑ Public Works
Environmental Health: ❑ Solid ❑ On-site ❑ Wells ❑ Food ❑ Other
Investigation Date and Findings:
Date Closed: Reason Closed: Initials:
i
SECTIONDELIVERY
-0 ..
= ❑Agent
!ti For delivery visit our website at '/`i
O information, ( Id J ❑Addressee
i �' Minted Name) C. D ate of Delivgry
o, Certified Mail Fee g507�� 1 6)
/Z
tti S Q 9 =ss different from item 1? El Yes
M Extra Services&Fees(check box,add tee as p �d
❑Return Receipt(hardcopy) $ ;livery address below: ❑No
C3 ❑Return Receipt(electronic) $ tswtma V
❑Certified Mail Restricted Delivery $ ,\0 Hera
0 ❑Adult Signature Required $ 0
❑Adult Signature Restricted Delivery$ Q�
O Postage
rq $ us?S�
na Total Postage and Fees
$ ❑Priority Mail Express
—n Sent
pT
❑Registered
MailTM
� cted Delivery ❑Registered Mail R e stricted
�` Delivery
f a No:"""" Bd Delivery ❑Return Receiptfor p` U V� = L Merchandise
Gi State Ifs+-i stricted Delivery ElSignature ConfirmationTM
❑Signature Confirmation
:.r r „ ,,,•r. dDelivery Restricted Delivery
PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
USP # First-Class ivW
Postage&Fees Paid
USPS
Permit No.G-10
9590 9402 1833 6104 2751 41
United States •Sender:Please print your name,address,and ZIP+4®in this box*
Postal Service
I
I
Mason County Conxnunit
615 W.Akler Street
MOM WA 9VA4 OCT 16 2017