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Home My WebLink AboutBRN2008-00066 - BRN Permit - 6/5/2008 ` w5_7_� BURN PERMIT Mason County Dept. of Community Development PO BOX 186 - 426 W Cedar St, Shelton WA 98584 - 360.427.9670 R N 2008 =00 066 6 ,, j5e- 0 %0 — 7on- s .. d g Issue Date Expiration Date Site Address: PENDING ROAD NAME 223184400080 18 23 2 Parcel Number Section Township Range Fire District JESSICA STOTTS Applicant PO BOX 863"SILVERDALE WA Address 360-621-0570 360-731-2720 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. ._4 7. Do not burn if wind is blowing more than seven (7) MPH. —0 0 8. Do not burn if wind is blowing from direction. > ca 9. The minimum people required to be in attendance at the fire while burning: 1 m 10. On site water required? �� m M 11. Provide excavator / dozer with a fire extinguisher at the site with a qu ied operator. 12. Provide a 24-hour fire watch. fl — 13. Fire must be completely extinguished within three (3) days after ig ition. �� 4 14. Fan is required. 1.5. Other: m Fire Warden: Signature ate --YOU MUST CALL (360) 427-7761 EVERY MORNING T R T IN** BRN2008-00066 06/05/2001 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`�ityc: c4ri\ '� State Zip Code City State Zip Code Phone *-)a,kJ7(..2J -(0' -)O Other Ph.\.V-,c)) 7,31-272i0 Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. Email Address CC)kX0 E Mail Address Drivers Lic.# ,t43FIT DOB - Drivers Lic. # DOB PARCEL INFORMATION - 12 Digit Parcel No,_z-2 Fire District- ❑ Is property flagged or addressed prior to inspection?nes / No Site Address(Please include street name, street number and city) 193 1 Tf�1�*fit C,L i-3 � ��c��►r DiNctions to site — + c c° Will tim er be cut and sold in parcel preparation'?Ye No Is property within 200' of Saltwater� Lake River/Creek Pond Wetland N Seasonal Runoff_ Stream t'`7 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? Yes/No Burning is authorized subject to the following conditions: ❑Valid permit must be on site while burning I2,16rohibited 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 Memissions,dense smoke, or obnoxious odors when burned. materials must originate from the property on which the burning is to occur. e fire must not create a nu an smoke,obscure visibility on public roads and highways,or endanger life and property. ximum pile size is twenty(20)feet i diameter, a minimum ten(10)feet firebreak must be constructed around each pile. ch pile must be at least ontrndred(100)f �t from any structu�,at least fifty(50)feet from standing timber. not burn if wind is blowing more than seve (7)' iles per hour. ❑ o not burn if wind is blowing f\om ( ction) esponsible adult and equipment shall be required to be on site and in attendance at the fire while burning. apide ite water requireid.: ❑Yes ❑No EXCAVATOR/DOZER with a fire extin at the site with a qualified operator.de 24 hour fire watch. e must be completely extinguished within hree(3) s after ignition. required ❑Other 0 Upon completion of above conditions,applicant must call 60)427-9670 Ext.459 fo"0pection prior to burning OWNER/CONTRACTOR Acknowledges submission of inaccurate inform ion may resv sop 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 parry 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 maximum, addition I inspections will require a of sixty four(64)dollars per inspection. X Date: ners �SL€ ' ner/OwRe resentative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: ate DEPARTMENTAL REVIEW APPROVED DENIED NOTES Fire Marshal FEES Burn Permit F e [SD Site Inspection Violation Fee State Fee Pre-Paid at Submittal Other TOTAL FEES