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Home My WebLink AboutBRN2024-00037 - BRN Permit - 5/6/2024 EXPIRAT�tQ6g. Permit#• BRN 2l124- DO ?�-O1 MASON COUNTY BURN PERMIT APPLICATION MAY 0 6 204 615 W Alder St• Shelton. WA 98584 APPLICANT/OWNER INFO CONTRACTOR INFORMATION: Owner�1a\)i1Z) Owner F Mailing Address Mailing Address City State w(jZip City�.�1 ) C. State�_Zip Phone Cell PhoneM -�� 7 tl�� Phone'No l{C� }-> J f Other Phone Lien/Title Holder Contractor Reg.# E-mail address E-mail address k\4 u : rvi ct ki Drivers Lic.# D.O.B. Drivers Lic.#&0 i.�j 7 L 13 P_ 5 P.,gD;7 D.O.B. ) TAX PARCEL NUMBER �a a-�-- SU L 0 U (12 digit number) Fire District SITE ADDRESS(please include street name,number&city)ei A Directions(to the site) 1 � c 2-e jky� iA 4 e n L-�—�-H o(o J h ST r Fj`'� ` on Y"A CA I rJ on BURNING IS AUTHORIZED SUBJECT TO THE FOLLOWING CONDITIONS: • Valid permit MUST be onsite while burning. If permit is not on site during burning the fire will be extinguished at your cost. • The following materials are prohibited and 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 releases toxic emissions,dense smoke,or obnoxious odors,when burned. • All materials must originate from the property on which the burning is to occur. • The 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. • Each pile must be at least one hundred(100)feet from any structure and at lease fifty(50)feet from standing timber. • Do not burn if wind is blowing more than seven(7)miles per hour.DO NOT BURN IF WIND BLOWING FROM • A responsible adult and equipment shall be on site and in attendance at the fire while burning.Must provide 24 hour fire watch. • On Site Water is required for permits between April 15'b and Oct. 15'h.A pump truck or trailer with 300 gallons of water loaded and 200 ft of hose. (The pump must be capable of pumping 20 gallons per minute through a one inch(diameter)50 foot section of hose.) • Provide EXCAVATOR/DOZER(with fire extinguisher)on site with qualified operator. • Fire must be completely extinguished within three(3)days after ignition. • Fan required. • Upon completion of above conditions,applicant must have inspection&approval before ignition.Call (360)427-9670,ext.262 • APPLICANT'S MUST CALL 360.426.4441 EACH DAY TO REPORT BURNING ACTIVITY. • APPLICANTS MUST CALL 360.539.7610(ORCCA) EACH DAY TO REPORT/REOUEST ANY AIR QUALITY ISSUES ASSOCIATED WITH BURNING. ************IF BURNING WITHOUT CALLING IN,THE FIRE WILL BE EXTINGUISHED AT OWNERS EXPENSE AND POSSIBLE SUSPENTION OF PERMIT.*************** • After the burn is complete make sure the fire has not burned into the earth by checking the fire location for hot spots. • It is advisable to pump the entire content of the water tank onto the burn site to assure the fire is completely extinguished. The permitted individual is responsible for any rekindling on the fire/burn site. • A BURN BAN when implemented by Fire Marshal will take effect as noted and all permits become null and void.After a bum ban has been implemented, all fires must be extinguished immediately. • Permit includes two(2)inspections maximum,additional inspections will require a re-inspection fee. (at current rate) • Access must be passable with 2 wheel drive vehicle Date Received., Application continued, please go to next page b Rev.Aor 19.2017 Burn Permit # PARCEL AND SITE INFORMATION: Parcel within o : a a er❑ LaKe❑ Krver/CreeIVStreani❑ Pond❑ Wetlands❑ Seasonal Kunott❑ es one Slopes or Bluffs> 15% Yes/No Will timber be cut and sold in parcel preparation?Yes/No Does Site require FPA or 6 yr.Moratorium: Yes/No Is site being converted or replanted:Yes/No Is site located in an Urban Growth Area(UGA)?:Yes/No/Unknown (Burning is currently NOT allowed inside UGAJ zoning.- Summarize proposed land clearing items to be burned: SITE PLAN (to be verified and approved by Planner) In the space provided below,please draw a top-view site plan of the parcel and notate locations of the following items with distances to/from`Burn Pile": o Burn Pile and Feeder Piles o Any existing buildings/structures (ie: Residence, Garage, Storage shed, Driveway, etc.) o Existing standing timber o Any "Critical Areas" such as Steep Slopes, Lake, River/Creek, Wetlands, Seasonal Runoff, Streams, etc - - - - - - - - -- - - - - - - - - - - - -- - - - - - - - - - -- - - - - - - - -- -- - - - - - - - - - - - - -- - - - - - - - - - - - - - - -- OWNER/CONTRACTOR:Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. The owner represents that the information provided is accurate and grants employees of Mason County&local fire authorities access to the above described property and structure for review and inspection. The person in charge of the fire will be liable for the cost of suppression if the fire gets out of control or if becomes necessary to extinguish the fire as the result of an enforcement action. X SIGNATURE- MUST BE SIGNED BY PROPERTY OWNER Date Signed FOR OFFICIAL USE ONLY: PLANNING DEPT REVIEW: Approved by&date: Denied by &date: Burn Permit # PARCEL AND SITE INFORMATION: -� Parcel within 200'of. Saltwater❑ Lake❑ River/Creek/Stream❑ Pond❑ Wetlands❑ Seasonal Runoff❑ : Yes/ one I Slopes or Bluffs> 15%within 50 feet Yes/ o Will timber be cut and sold in parcel preparation?Yes o Does Site require FPA or 6 yr.Moratorium: Yes N Is site being converted or replanted:Yes o Is site located in an Urban Growth Area(UGA)?:Yes/No nkno [Burning is currently NOT allowed inside UGAJ Zoning: Summarize proposed land clearing items to be burned: SITE PLAN In the space provided below, please draw a top-view site plan of the parcel and notate locations of the following items with distances to/from"Burn Pile": o Burn Pile and Feeder Piles o Any existing buildings/structures(ie: Residence, Garage, Storage shed, Driveway, etc.) o Existing standing timber o Any"Critical Areas" such as Steep Slopes, Lake, River/Creek, Wetlands, Seasonal Runoff, Streams, etc - - -- - - - - - - - - -- - - - - - -- -- -- -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - OWNER/CONTRACTOR:Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.The owner represents that the information provided is accurate and grants employees of Mason County&local fire authorities access to the above described property and structure for review and inspection.The person in charge of the fire will be liable for the cost of suppression if the fire gets out of control or if becomes necessary to extinguish the fire as the result of an enforcement action. X L S TURE-MUST BE SIGNED BY PROPER WNER Date Si ned FOR OFFICL4L USE ONLY.- ,PLANNING DEPT REVIEW: Date: _ _ Approved by: ___ Denied by:.___—_— N/A - No Critical Areas �