Freedom Of Information Request Form - Ogle County
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1FREEDOM OF INFORMATION REQUEST FORM
Name:
Date:
Address:
Phone: (
)
-
Fax: (
)
-
State/Zip:
email:
Address of property:
(Include Lot # and Subdivision Name if applicable)
Township: _____________; Section: _____________; Range: _____________; Quarter Section: _____________
Please check the type of information you are requesting:
_______Existing Private Septic System
_______Food Establishment Inspections
Time Period:
_______Existing Private Well
From: _______________to______________
_______Soil boring information
_______Other:_____________________________________________________________
_______This request is for commercial purposes (this information must be disclosed upon request)
*Please circle your preferred method of delivery for the information requested above: FAX
EMAIL
MAIL
Signature of requestor:
*(THIS INFORMATION WILL BE AVAILABLE WITHIN 5 WORKING DAYS OF YOUR REQUEST UNLESS
OTHERWISE NOTED AS BELOW)
Duplication Fee Schedule for copies after 50 pages:
Paper copy from original
504 per copy
Certification of Public Records
No Charge
Information below line to be completed by the Freedom of Information Officer:
_____The above request for above captioned records have been approved. The documents will be made available upon payment of
copying costs in the amount of _________________ (if applicable).
_____A limited search of our accessible records produced the enclosed documentation for the above captioned property.
_____A limited search of our accessible records revealed no available documentation on the above captioned property.
____The Ogle County Health Dept will need an additional 5 days to locate and prepare the requested information.
____This request is denied as it places an unreasonable burden upon the Ogle County Health Dept.
Freedom of Information Officer:
Date:
OGLE COUNTY HEALTH DEPARTMENT
907 WEST PINES ROAD
OREGON, ILLINOIS 61061
815-732-7330
815-732-7458 (FAX)
Email:
U:\cag\OCHD\Office Forms_Misc\FOI-Request Form_Most Recent.doc, Rev.Aug.2013
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