HomeMy WebLinkAboutOwner is Furious Working-Digging Up Lawn Area Right at Lake - GRD Letters / Memos - 11/13/2009 s
Mason County Investigation Report Form
Case Number. �(J F-zonk o C')O q - Parcel Number: �a 33 d
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Violation Site Address: ,35d & I"�. DI2. iQtiK
Property Owner(s): Phone#:
Mailing Address:
Tenant/Contractor/Operator on site:
Complaint Received by: Phone ✓ Email Web Site In Person
Directions to Site: 4a `/l°V — —
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Description of Concern:
Department of Concern: Building Planning V Fire Pubic works
Environmental Health: Solid Onsite Wells Food Other
Investigation Date and Findings:
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.
If filed,your name will be disclosed if you are a witness 4n 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 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: