Environmental Health

REQUEST FOR PUBLIC RECORDS

Please use this form to request public records.
We will get back to as soon as possible.

* Required
1. Requestor Information
* Name:
* Phone:
2. Please state the name & address of the public record you are requesting: (one record request per submission)
* Record Name:
* Record Address:
	Multiple requests received on the same day from the same individual or organization will be treated as a single request.
3. Type of record(s) you are requesting:
	Water Well Logs
	Water Quality Reports
	Septic System Drawings/Permits
	Pump Card
	Other:
4. I wish to	Examine the record
	Receive a copy of the record via mail, fax (less than 20 pages), or e-mail:
	Mail:
	Fax:
	E-Mail:
* Verification Code:	(This helps prevent automated e-mails.)
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The Kalamazoo County Health and Community Services Department programs are open to all without regard to race, sex, color, national origin, religion, height, weight, marital status, political affiliation, sexual orientation, gender identity, or disability.

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