HomeMy WebLinkAboutBRN2009-00053 - BRN Permit - 12/11/2009 BURN PERMIT
Mason County Dept. of Community Development
PO BOX 186 - 426 W Cedar St, Shelton WA 98584 - 360.427.9670
BRN2009 =00053
i�t 0 18*4r- O - I 'W Afj•4*9
Issue Date Expiration Date
Site Address: 20 E CASCADE VIEW ALLYN
122311450060 31 22 1 5
Parcel Number Section Township Range Fire District
Applicant: EARL J IDDINGS
Address: P O BOX 2755 BELFAIR WA 98528
PAG: 1.206.391.7502
Contact Number(s) - Must be a 24 hour number
Conditions:
1. Valid permit must be on-site while burning.
2. The following materials may 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 emissions, dense smoke or
obnoxious odors when burned.
3. All material must originate from the property on which the burning is to occur.
4. The fire must not create a nuisance from smoke, obscure visibility on public roads and highways or
endanger life and property.
5. The maximum pile size is twenty (20) feet in diameter, with a minimum ten (10) feet firebreak around
each pile.
6. Each pile must be at least one hundred (100) feet from any structure and at least fifty (50) feet from
standing timber.
7. Do not burn if wind is blowing more than seven (7) MPH.
8. Do not burn if wind is blowing from direction.
9. The minimum people required to be in attendance at the fire while burning: 1
10. On site water required?
11. Provide excavator / dozer with a fire extinguisher at the site with a qualified operator.
12. Provide a 24-hour fire watch.
13. Fire must be completely extinguished within three (3) days after ignition.
14. Fan is required.
15. Other:
Fire Warden:
Signature Date
"YOU MUST CALL (360) 427-7761 EVERY MORNING TO REPORT IN**
BRN2009-00053 12/10/200!
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 Company Name
Mailing Address Mailing Address
City L i :c State J&L4--Zip Code S City State Zip Code
Phone 2 C6 70 1--230a Other Ph. Phone Other Ph.
Lien/Title Holder — ��'ti — Contractor Reg. # Exp.
E mail Address I� 6) Cr-2:3 E Mail Address
Drivers Lic. # =t�t�+.,F:T 3 •f�C�DOB - Z /`i?
Drivers Lic. # DOB
PARCEL NUMBER: I �� �,] /q Q060 Sec. Town. ;'_ Rng.�_Fire District
Site Address(Please include street name, number and city)
Directions to site
Parcel within 200'of Saltwater❑ Lakep River/Creek❑ Pondp Wetland p Seasonal Runoffp Streamp Slopes or Bluffs,.,?,- 15%
Is property flagged or addressed prior to inspection Yes/No-Will timber a cut and sold in parcel preparation? Yes f No
Reason for land clearing: C e«� n C� \ C. ��
Is this site being converted or replanted? Yes / o Does site require FPA or 6 yr. Moratorium? Yes`/No
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? Yes/No
JJ Burning is authorized subject to the following conditions:
lid permit must be on site while burning.
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 normally releases toxic emissions,
_Odense smoke,or obnoxious odors when burned.
Fd_A{{materials must originate from the property on which the burning is to occur.
Q_,- 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)foot firebreak must be constructed around each pile.
0 Each pile must be at least one hundred(100)feet from any structure, at least fifty(50)feet from standing timber.
7Do not burn if wind is blowing more than seven(7)miles per hour.
o not burn if wind is blowing from (direction)
�A responsible adult and equipment all be required to be on site and in attendance at the fire while burning.
rP
site water required: OYes o
vide EXCAVATOR/DOZER(with a fire extinguisher)on site with qualified operator.
vide 24 hour fire watch.
e must be completely extinguished within three(3)days after ignition.
Fan required
1 O r
ffe
pon completion of above conditions,applicant must call(360)427-9670 Ext.262 for inspection 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 neoes-
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
inspection. This permit/application becomes null and void if work is not completed within 30 days. Permit includes two (2) inspections ma)amum,
additi I inseection 'II r quire a fee of sixty four(64)dollars per inspection.
X ' Date:
OwWr/Owners Representative/Contractor indicate which one `
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date 10 0�
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Fire Marshal
FEES
Burn Permit Fee Site Inspection Violation Fee
State Fee Pre-Paid at Submittal Other
EXPIRES: Date: Inspector TOTAL FEES