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HomeMy WebLinkAboutBRN2007-00085 - BRN Application - 11/4/2007 PERMIT NO. MASON COUNTY BURN PERMIT APPLICATION ` 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360)427-9670 • Belfair(360) 275-4467 • Elma (360)482-5269 •www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 0 Company Name �"� £xc-.ty 16,4 LL Mailin Address �— Mailing Address_ SE S-0o -co /,*-94 City State� ip CodegW,13 City -0t&#01V State w- Zip Code Phone —4('-73 Other Ph. Phone —aoo3 Other Ph. _ Lien/Title Holder Contractor Reg. # it 7 7 Exp. E mail Address E Mail Address Drivers Lic.# OB Drivers Lic.# .✓d46 DOB PARCEL INFORMATION - 12 Digit Parcel No oZ;- Fire District 13 Is property flagged or addressed prior to inspection? Yes / No ©Lt 0.-V Site Address(Please inclilde street name, street number an city) Directions to site AK I a Q o eX OPAL Will timber be cut and sold in parcel prepay tion?Yes Is property within 200' of Saltwater Lake --diver/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% The person in charge of the fire may be liable for the cost of fire supression if the fire gets out of control or if it becomes necessary to extinguish the fire as a result of enforcement action. Open burning shall be prohibited during any period of impaired air quality as designated by the Olympic Region Clean Air Agency,or during extreme fire danger due to dry weather conditions as designated by the Mason County Fire Marshal's Office.Information hotline(360)427-7799 Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? Ye o Burning is authorized subject to the following conditions: lid permit must be on site while burning Prohibited materials.the following must not be burned: Garbage,dead animals,asphalt, petroleum products,paints, rubber products, plastics, paper,cardboard,treated wood, construction/demolition debris,metal, or any substance(other than natural vegetation)that normally releases toxic fissions,dense smoke,or obnoxious odors when burned. materials must originate from the property on which the burning is to occur. athe fire must not create a nuisance from smoke,obscure visibility on public roads and highways,or endanger life and property. Maximum pile size is twenty(20)feet in diameter,a minimum ten(10)feet firebreak must be constructed around each pile. _Fach pile must be at least on om any structure,at least fifty(50)feet from standing timber. �TDo not bum if wind is blowing more than seven(7)miles per hour. �Do not bum if wind is blowing from '-(`direction) 811responsible adult and equipment shall be required to be on site and in attendance at the fire while burning. 01�n site DYes MNo P��•ovid A OZER with afire extinguisher at the site with a qualified operator. 8Provide24 hour fire watch. ii'y�,s 0 Fire must be completely a wished within three(3)days after ignition..13 Fan G� Cqw 0 Other�uired A.,O ,� .� © C I� 0 13 Upon completion of above conditions,applican must call(360)427-9670 Ext.456 for insoection prior to burning OWNER/CONTRACTOR Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the neces- sary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property for review and Iinspectio . This permit/application becomes null and void if work is not completed within 30 days. Permit includes two(2) inspections ma)amum, additio I i spectior�AvWARequire fee of sixty four(64)dollars per inspection. i X Date: Owner/Owners Representative/Contractor indicate which one FOR OFFICI BEYOND THIS P INT Accepted by: Date DEPARTMEN ENIED TES i Fire Marshal FEES Burn Permit Fee Site Inspection Violation Fee State Fee Pre-Paid at Submittal Other TOTAL FEES c MASON COUNTY FIRE MARSHALS OFFICE Mason County Building III Fire Marshal (360) 427-9670 ext. 273 426 West Cedar Street Fire Warden (360) 427-9670 ext. 459 P.O. Box 186 FAX (360) 427-7798 Shelton, Washington 98584 DATE: 4 October 2007 TO: Fire District#4 FROM: Robert Molesworth Fire Warden SUBJECT: BRN#2007-00085 FYI The burn site is at 8352 Lynch Road. Contractor is putting up an address sign. Access to burn site is behind a locked gate, approximately one quarter mile down a very narrow gravel road toward the water. There is room to turn around at the end, but in loose dirt. i D o 7 FAI, Date:4 , f