HomeMy WebLinkAboutBRN2020-00091 - BRN Permit - 12/15/2020 EXPIRATION DATE: Permit#: BR.N Q?0 aD
MASON COUNTY BURN PERMIT APPLICATION
615 W Alder St • Shelton,WA 98584
SHELTON 360.427.9670 x352 •BELFAIR 360.275.4467 x352 . ELMA 360.482.5269 x352
APPLICANT/OWNER INFORMATION: CONTRACTOR INFORM ATION:
Owner /VlGlC '�/IOC4s Owner
Mailing Address 0 $ Z— Mailing Address
City StatcLd-k Zip City _State Zip
Phone'3(ov 5 35 Cell Phone Phone Other Phone
Lien/Title Holder Contractor Reg.# Exp•
E-mail address MOZ,C, AWA1Q(-&/ " &►f9-5-5-r- E-mail address
Drivers Lic.#WAA0u4-'i++ — D.O.Boss+-1110 77 Drivers Lic.# D.U.H.
TAX PARCEL NUMBER 2 Z 3 31 - S 2 ^ oo b (12 digit number) Fire District
SITE ADDRESS(please include street name,number&city) �� Ili e—� P L
Directions(to the site) fl je�fl 7ht±:N R 0-0 '7101 totx_,✓s LA-,11�4r TO M r Vi e-J PL
t A--r <tJO OF e'V l:1e j'0t-e_
BURNING IS AUTHORIZED SUBJECT TO THE FOLLOWING CONDITIO1NS:
• Valid permit MUST be onsite while burning If permit is not on site during burningthe e 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.
• Ail 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 burry 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 urovide 24 hour fire watch.
• On Site Water is required for permits between April 15`h and Oct. 15".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 EXCAVATORIDOZER(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/REQUEST ANY A11R QUALITY ISSUES
ASSOCIATED WITH BURNING.
************1F 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.
• Tt 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 fireiburn site.
• A BURN BAN when implemented by Fire Marshal will take effect as noted and all permits become null and void. After a burn 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.Aar 12.2017