HomeMy WebLinkAboutBRN - BRN Permit - 3/28/2005 Mason County Fire arshal's Office
La Clearing€� Agricultural ❑
Notify before ignition: . "- 9 - ! Phone: 659 7 Y—5 s-�>
Sec.�Twn. l ►t�R (E) Tax Parcel: (12 digits) ot
Directions to burn site: Q
—4-AllCf'1 nr= A 2—
The person in charge of the fire may be liable for the cost of suppression if the fire gets out of control
or if it becomes necessary to extinguish the fire as the result of an 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 an extreme fire danger due to dry weather conditions
as designated by the Mason County Fire Marshal's Office.Information hotline(360)427-7799.
-ABURNING IS AUTHORIZED SUBJECT TO THE FOLLOWING CONDITIONS:
❑ id permit must be on site while burning
PROHIBITED MATERIALS. The follow 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.
0 All material must originate from the property on which the burning is to occur.
0 The fire must not create a nuisance from smoke,obscure visibility on public roads and highways,or
,,Anranger life and property.
Y Maximum pile size is twenty(20)feet in diameter,with a minimum ten(10)feet 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.
❑ Do not burn if wind is blowing more t seven(7)mph.
❑ Do not burn if wind is blowing fro (direction). /
0 Minimum people required to n attendance at the fire while burning: Y
❑ On site water re uired: es ❑ No
❑ Provide ATO DOZER with afire extinguisher at the site with a qualified operator.
❑ Provide 24- our ire watch
❑ Fire must be completely extinguished with in three(3)days after ignition.
❑ Fan Required
❑ Other: Q
Validation Date: P6 F} V!J Expiration Date: A2L_ �$ V
FOR OFFICAL USE ONLY
�/
Fee Amou t: Check No::77/-S Received By: 5/MEst.Tonnage,�&
Attach chec a e to Mason Count Treasurer.
Issued b
I declare that I am the owner, owner's legal representative,or contractor.I further declare that I am entitled
to receive this permit and do the work as proposed in the application. I declare that I have obtained the
permission from all necessary parties. If permission is required from any easement holder or any other
party interest regarding this application or work proposed in the application,I have obtained permission
from them to apply for this permit and conduct the work as proposed.
Landowner Name: Address:
Telephone Number: ( ) /
Agents Name: VI?T �� ,Lr'L�� Address: -3(`*4 tjoxls jilt, 19` TQ 41��
Telephone Number:(�(,�) 'j 3/-�,/2? Ltl/
Signature of Landowner Agent: please indicate)_ LzztA Date S34S
Original-Fire Warden Copy-Permit Holder