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Home My WebLink About005-393-009.! ..s.' '(a• -. _" , 7 7 > i �+, Oft • '' LARRY D McNIEL R., h� jet'15 1211 Martin, Chic i�r►, Contr : Thomas*co S AXt Permit #5464`-78B (reroo ' .. t . r + Pe�niR `558-80P,EiutilMH) ELEC.a_�� GASL�O�'� SUPPORT STRUCTURE - Q.. mmPACTION TEST REQ. f Contr : Beicli MH ales • Permit#244s-�3UMHI Is s u Y 4 t i 1 1 I 1 t. e i Temp. Power Pole Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas. Serv. Called PG&E JOB FINALED • (Date (Signature) • i PERMIT NO. 5464=7$B PERMIT EXPIRES OWNER LARRY D. MCNIEL CONTR. Thomas Const., Oroville LOCATION '(A.P. 46-113-9 1211 I Martin, Chico Temp. Power Pole Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas. Serv. Called PG&E JOB FINALED • (Date (Signature) • i Setback Forms Main B Foot Piers Garage Footings Stemwa I I Slab Carport Footings Slab Patio Footings isonry Walls Relnf. Steel COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD ING BUILDI G (Cont'd) L Firewall I Soil Pipin Restroom Finish Windows Siding Roof Sheathin Roofing Fdn. Vents Garage Vents Insulation Prov. for ph sically handlcaooed Conformance of ex. Footin Throat Final 1st Floor 2nd Floor 3rd Floor To out Water Piping Sewer Fixtures Water Htr. Heaters Appliances Gas Piping & Test Temp. Gas Sanitation Final MNG '• ELECTRrICAL Bond Beam 1 I FIRE SPRINKLERS I Motors I Stucco Mesn MECHAN AL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final MOBILEHOMEUTILITIE-----------------• Elec. Service Elec. Pedestal Water Piping Sewer Gas Piping E OME INS A L TI N - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATERKS OR CORRE0TI S (NOTE: An entry must be made on this form each time you visit the job site.) COUNTYF A 0 ,BUTTE DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 Tel ephone:' 534-4541 APPLICATPON AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. Date Signature of Permitee or Agent Receipt No. 1 R_/ 2ZO White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTUFWF'RUBLIC WORKS By Date �j'_ l `1 ^7 d 1lding permit expires Date r — 7 M BUILDING Owner ,�y4le 0- /L�4 SQ. FT. OCC. BUILDING VALUA N CSa Mailing Address Telephone No. Contractor � 6 '^ Mailing Address J (�}� Fireplace Total Valuation Pep c Telephone No. - Permit Fee r L:l, iD Building Address 1 P I an Check i ng Fee &/or Penalty Permit Fee PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Ga Repair drainage or vent piping 1.50 r.. // A. P. No. `" Zoning 8 Planning Water piping 1.50 Each gas water heater or vent 1.50 s 8ai�+ta>iect Fire Dept. Fire Zone Use Permit Gas piping system 1 -5 outlets 1.50 EQA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 ans ec'd Parcel Aroyal Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Permit Fee $ $ Z, ELECTRICAL No. @ FEE PERMIT FILING FEE $3.Oa Main service 600v OR LESS 100 AMP OR LESS 5.00 Single Family Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service OVER 100 AMPeo0v OR LESS 25.00 Main service EA. ADD•L 100 AMP 1.00 OR ADDNSNEW T // %ACCDWELBLDGS.LING CCUP. 7e\ 20sgft. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of Cal' ornia Business & Professions Code under the name st le of: y NEW RESID,CONSTBRANCH CIRCUITS) NON -REBID BRANCH CIRCUITS 2.50ea NEW CONSTR /POWER APPARATUS a NON -RES ID. (POWER OUTLET CIR. Ex. Occup{OUTLETS OR FIXTIiaES B LLO; Ex. OCCU FIXED APPLNS. OR P•� 0UTLETS (RESID.) EAJ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 9 License No. �a �` Classification Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. IAF I certify that in the performance of the work for which this LAJ permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation [#2.00 Hood . Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relatinq to buildinq construction, and hereby Land Development Fee $ TOTAL PERMIT FEE $ cj authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. Date Signature of Permitee or Agent Receipt No. 1 R_/ 2ZO White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTUFWF'RUBLIC WORKS By Date �j'_ l `1 ^7 d 1lding permit expires Date r — 7 M j' 558-80P,E PERMIT NO. ' 4 . PERMIT EXPIRES OWNER Larry McNiel J CONTR.� owner ;LOCATION (A.P. 46-113-9 ) 1211 Martin St., Chico D Yt . r 'j Temp.Po er Pole Called PG&E Serv. ' ��Elec. CaNled PG&E a Tempi Gas Serv. ailed PG&E /INALED' ' I (Date) 1/41 (Si a re) .a 9 COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) -PLUMBING Seloack Aewall ski Piping For Pa ets 7 t Floor Mai Bldg. Rest om Finish 2n Floor Fo ins Windo 3rd oor Stem all Siding To out Slab Roof Shea)blng Water PI i Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Stemwa l l Garage Vents Insulation Water Htr. Heaters Slab Carport Footings V Prov. for physical handicaped Conformance of ex. structure Appliances Gas PipIn &Test Temp. Gas Slab A Final Sanitation Patio REP CE Final Footings Footing EIIECTRICXL Masonry Walls Throat Rough Relnf. Steel Final Fixtures Bond Bea ;FIRE SPRINKLE Motors Framinq Test Water Htr. stucco, Final Sub anel Mesh MECHANICAL Gird. Failt Prot. Scralth HeatIA Servi B n Coo ng TAO, Pole F nish D is nder round I erior Lath entllation / Permanent oor Closer Final inal MOBILEHOMEUTILITIES ------------------ Elec. Service _Eiee-44mJ Water Piping Sewer BI E OME INS ALLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) MOBILEHOME . INSTALLAT`ION INSPECTION CHECK LIST 1. Is the mobilehome located w't quired separation from lot lines and buildings and generally conform to plot plan? Yes_ No_ 2. Does the mobilehome have required clearances above -ground? (Sec.5085) Yes `—� 3. Are footings and. supports properly sized, spaced, and braced as per aed plans? (Note possible variation at spring shackles.) (Sec. 508 5083) Yes No 4. Is the mobilehome level? (S 88) Yeses No ( 5. f more han a utfit a r ox ro rl ins lied? (Sec. y e s. N o `�cJ 6. Water A. Is flex- e connector of adequate size and properly installed .(1/2" ID min,)? (Sec. 5566) Yes No B. Test - Does water piping withstand iking pressure or 50 lbs. air test? Yes`—N C. Backflow - If coach is note ornia approved, does station have backflow device and pressure -relief valve? 7. Wastes and brains � � � A. Is connection made with Schedule 40 DWV and have flex connectors at each end?/Yes -'-'Io B. Does it have minimum" per foot slope and is it properly supported? Yes `�No C. Are any leaks detected in drainage system after running 3 -gal of water through each fixture including wa hing machine standpipe? Yes No D. If coach is Sef California approved, does station have required•trap and vent_? Yes No l/� 8. Gas Piping and Gas Vents A. Conne or - Is mobilehome connected to the as supply with an approved 3/4" minimum mobileh a connector not more than 6 ft. Ong? Note: All piping is to be at least as large as 'emobilehome gas line��irilet w thout reductions other than the mobilehome connector. No 5 i B.• Test OK as per fo Xeedure? Yes_ No 1. Open all applia connector v ves. _ _ 2. Shut off appliaa _pilot valves: 3. Air test with m10"=14" water column, or test with slope gauge (minimum6oz.-maximum 8 a d in tenth pound increments. Test for 10 min. without drop. 4. Connect gas metehome wi h connector, turn on gas, test connections with soapy water. C. Are all appliance venr properly installed? \es No 9. Electrical A. Is service large enough to provide ade uate,amperage-to mobile:Zome (must equal rating o� mobilehome with a minimum of 100 p and other facilities on lot, i.,e.,`water pumps, garage, cabana, etc.? Yes_ o_ B. Is there proper clearances around panels? Yes No / C. Is ower supply -cord` - or feeder assembly properly fused? Yes,-, O PYP. P Y D. Is continuity'test satisfactory as per the following procedure? Yes_ o 1. De-ener •fie electrical wiring system of the mobilehome at the pedestal. 2. a sure that the power supply cord or feeder assembly conductors, including neutral conducto , have been disconnected. q 3. itch all breakers and switches in -the mobilehome to.the-"on" position. 4. &oa �ectone lead of a test instrument to the mobilehome grounding conductor and apply the her lead to each mobilehome supply conductor, including neutral. 5:^' non-current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. U ompletion of the above procedure, the power supply cord or feeder assembly conductors shall be connected to the site service equipment. A further continuity test shall then be made between the grounding electrode and the chassis of the mobilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. 10. Is job card signed by Health Department for water and sanitation? 11; If everything okay, sign -off card and tag services. MOBILEHOME DATA Manufacturer and/or Names.tyle V r Lengthy 5-ZO Widt ` q Vehicle Serial No. State Identification No. Additional Inf rma ion or Comments: COUNTY OF BUTTE ' , •DEPARTMENT OF PUBLIC WORKS 695 Oleander Avenue, Chico — Phone 343-4211, Ext. 70 7 County Center Drive, Oroville — Phone 534-4541 Skyway and Elliott Road, Paradise — Phone 877-3435 CORR CTS NOTICE///,. D X-' ILDING OR PROPERTY ADDRESS A routine Inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office t when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediateiv. COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the reqquirements of the Galifo is dministrative Code, Title 25, Chapter ,6under permit numb eu.� �� f for the following location, Owner's Address Mobilehome Mfg. �j Model/;Year/ jLrf Insignia -N -o./ 7_ �! �� `Serial -No./ �-►� >' 7 It is hereby certified for occupancy at the above described location and may be occupied. 1 Director of Public Works Date THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White- Owner, Yellow- Installer, Pink - D.P.W. COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS ,, •� 7 County Center Drive ;.-_ Orovalle, California 95965 �� Telephonb: 534-4541 0 ' APPLICATION AND PERMIT AA P4 BUILDING Owner LA'P_Ty (Y) C aL SQ. FT. OCC. BUILDING VALUATI N Mailing Address 1I M146r/A) ST ca(fo _I �Pho56 0 Contractor n (�tJ(� f �1p 5 Mai I i ng Address Telephone No. Building Address M,41,2 -77A) 1;7— C t4a 0 '7'Ct4CO A. P. No. Zoning & Planning F kis I C. a ti ire Dept. FireZone Use Permit EQA I Parking Parcel Parcej/Ma 60' R/W I Improvements r Plans Declaration P p ovements Bldg. Flans Rec'd ParceTApproval $ Pans Approval NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ Permit Fee PERMIT FILING FEE $3.00 Plan Checking Fee &/or Penalty Single Family ❑ Duplex ❑ Mobil Home Others ❑ Permit Fee Main service PLUMBING CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: FEE PERMIT FILING FEE License No. Classification C1t I am exempt from the Contractors License Laws of the State of California. WORKMEN'S COMPENSATION INSURANCE I am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. RI certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date 01- Si ature of Permitee or Agent Receipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant Fireplace °1e@ BAL�1 $ Total Valuation ELECTRICAL No. @ Permit Fee PERMIT FILING FEE $3.00 Plan Checking Fee &/or Penalty Main service 600V OR LESS 100 AMP OR LESS Permit Fee Main service PLUMBING No. @ FEE PERMIT FILING FEE $3.00 C1t Each Trap 1.50 1.00 Repair drainage or vent piping 1.50 CCUP. Y) Water piping 1.50 NEW CONSTR. NON.RESI D. Each gas water heater or vent 1.50 Gas piping system 1 - 5 outlets 1.50 C Ea0,additional outlet .30 wilding sewer 5.00 (6. C Lawn sprinkler system 2.00 Permit Fee °1e@ BAL�1 $ S S.(x ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 3.W Main service 600V OR LESS 100 AMP OR LESS 5.00 Main service EA. ADD'L 100 AMP 2.50 2. Main service OVER 100 AMPP OR LESS O ' 25.00 Main service// EA. ADD'L 100 AMP 1.00 NEW CONS. OR ADDNST %ACCLBLDGS.DWELING CCUP. Y) 20sgft NEW CONSTR. NON.RESI D. MULTI.OUTL T BRANCH CIRCUITS)' 2.50ea EX. OCCUO(OUTLETS OR FIXTtIRES °1e@ BAL�1 FIXED APPLNS. OR EX. OCCU P. ( OUTLETS (RESID.) EAJ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 /5,60 Misc. Wiring 6.25 Permit Fee $ MECHANICAL No. @ PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 1 1 2.00 Permit Fee $ $ Land Development Fee $ -,5, oo TOTAL PERMIT FEE is SI 3, e This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR,QF PUBLIC WORKS By Date B/(ding' permit expires Date COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS .-1 CountV Center Drive - Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT ashy aumor(ze representanves or the county OT twtte co enter upon the above-mentioned property for inspection purposes. x e�f_`�� Date kv Signature of Permitee or Agent Receipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the BuJW County Code and/or resolutions to do work indicated abov,elfoy which fees have been paid. AR.ECTAR OF PUBLIC WORKS Date,;713 _/ 2-b" Building pe mit expires Date v%y�Q BUILDING Owner _ ,%E Q � SQ. FT. OCC. BUILDING VALUATION Mailing Address Z 4�OV, Cll,'e,® C,.f, .�1Tele 'an5 toSl e � , g, a Contractor_ , s Mai ling Address a j=- 1.4",rC,0 Fireplace Total Valuation ' S Telephone No. 3 a/1 r71/� Permit Fee Building Address ��/��fL�'' Plan Checking Fee &/or Penalty Permit Fee A/ I, G 0 G a 6 PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 " Repair drainage or vent piping 1.50 A. P. No. ✓ A Zoning�lanning Water piping 1.50 Each gas water heater or vent 1.50 Fire Dept. FireZone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 Bldg. Plans Recd Parcel oval s <pproval Lawn sprinkler system 2.00 NEW ADDITION UTILITIES ❑ OTHER Permit Fee $ $ &kfQLD ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main "service 600V OR LESS 100 AMP OR LESS 5.00 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD -L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Main service EA. ADD -L 100 AMP 1.00 NEW CONS. DWELING OR ADONST V ACCLBLDGS.CCUP. B) 20sgft CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name st le , y (( % JLC E NEW CONSTR (MULTIBRANCHCIR-OUTLET NON-RESID BRANCH CIRCUITS) J2.50ea NEW CONSTR. (POWER APPARATUS.a, NON.RESID. SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTIIRES W13 A :70) Ex. OCCUp• FIXED APPLNS, OR OUTLETS (RESID•) EA) " 2.00 Temporary service 10.00 �/�w,�®�e • G'd Mobile Home Facilities 15.00 C25-•1/0^��/� r v License No. �/�'<� Classification Cil Misc. Wiring 6.25 E] I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. I have placed on file with the County of Butte.a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ (J I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby Land Development Fee $ TOTAL PERMIT FEE $ �iU aumor(ze representanves or the county OT twtte co enter upon the above-mentioned property for inspection purposes. x e�f_`�� Date kv Signature of Permitee or Agent Receipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the BuJW County Code and/or resolutions to do work indicated abov,elfoy which fees have been paid. AR.ECTAR OF PUBLIC WORKS Date,;713 _/ 2-b" Building pe mit expires Date v%y�Q r - f r - r) BUTTE .COUNTY DEPARTr9FM OF PUBLIC WORKS `SPECIAL DIS'PEC!'IOM REPORT Owner:�� _ . Address: Tenant: Building Location: _/ Type of Inspection requested: 1. Pou.s Lng / ! 2. F inanc i.pg Other (specify)- - - y. A. P. 6 Date of Inspect io54 _4.C5 Inspecto 3. Change of Occupancy to Preseut use: cf building: A. Sanitation (Rou.sins 1. Grater closet: 2. Lavatory: - ? Bathtub or shower: -- -- 4. Kitchen. sink: 5. Hot and cold a;a.ter to fixtures: 6. Heating f2ellities: 7. Natural Light and venfilation: 8. Roem and spaca requirements: 9.Bedroom window or door for second exit—,.- 10. xit:_10. Infestation of insects, vermin, or rodents: 11. Connection to sewage disposal: - — '12.' Connection to ;water supply: ,13. Rubbish and garbage facilities: 14. Comments: B. Structural 1. Ps.ers and footings: 2. Floor constructioTi:w _ 3. Wall construction: - 4. Ceiling anti roof. construct ion 5. Firepl.,res:— C. Electrical Sezvicc. end szround:�__ _ 2. Receptacles:— 3. Fusi.ig:__ 4. Cotminnts: D. P limb in_g 1. Fixtures co_ -nect(,d and tie+atz.d: 2. �"as vater heater: 3. Cas hcating vekits: 4. . c. encs: E. Other 1. Maintenance and repair: 2. Fire hazards: 3. Safety hazards: 4. Weather protection: 5. Underfloor and attic ventilation: 6. Comments; F. Commercial Buildings 1. Roof covering: 2. Distance to property lines: 3. Physically handicapped: 4. Restroom floors and walls: _ 5. Exits: 6. fmprovements: 7. Zoning: 8. Comments: G. Field Problems or Violations 1. Problem or ;violation (give complete description): 2. What action taken (give complete description) 3. What action reconLmended: 77A. Information only - file. T-1 B. Hold for tea (10) days, then write Letter. C. Write letter. 77 D. Other. REPORT :fir., �'•� •`'$i—�f tQ° n I C-18 REV. 1-79 C UEN NUMBER REG RU �. IN't9ENT oo ". :'. .3 c��".2 S•r,�!Tr too r• UATE YEAR COUNTY FIRE NUMBER w FIRE NAME - -•• •••---•--••- •--•-. REG I R U FIRE # 2-1 BRUSH 2 LOCATION (CDF Direst P.A.) # f .� ? SEC:. TO'WNSHIr' INION RANGE �E MILES DIRECTION CI ( IN NTL. FOREST, FIRE DIST., CITY & STREET NO., ETC. •--••:••�-•• Z5 22 Os ow '12 roe$ ?�/R/ " , ------- RESAONSE TYPE ' SA ACRES BURNED (CDF Direct Protection Area only).' y FIR ❑FALSE ALARM ( L E STOP Tp iU AGENCYPR PROTECTION :< ....... ACRES R X.X. ..:•.;.:<. .. C_D.F. - - __ __. RESPONSIBILITY (AT ORIGIN)./.7---, ...... u DIRECT �✓ STATUTORY OTHER,... PROTECTION RESPONSIBILITY _ • _ . _,.. _ ..... .❑ STATE _ `TOTAL „ : DISTRICT t F. JE L O STATE N S ZO • ❑ E�p IJ xx STATE (� CITY . 8� (j LOCAL (Contract)• -❑ COUNTY SIZE CLASS u. .25 ACRE ❑ LOCAL (Non -contract) ❑ U.S.F.S. - i'i ❑-A OR LESS LOCAL ZONE ❑ B.L.M. __.._.... ®B .2s -s i _... ACRES LOCAL (Contract) ❑ B.I.A. ❑10-99 C ACRES ❑ LOCAL (Non -contract) ❑ N.P.S. v, _ is r - �� ❑ FEDERAL ZONE •D OTHER FEDERAL ; ®D ACR .. _..... . �J ❑ MISCJOTHER `, ❑ OTHER _ _.. ..'.. �(-1 300-999 .... . t L_)E ACRES �S CAUSE (Starts in CDF Direct F�rotection Area only) = ❑ F )000 999 t LIGHTNltJG ❑ DEBRIS E) PLAY W/FIRE I_j CAMPFIRE ❑ ARSON MISCELLANEOUS ❑G r CRES ;` SMOKING [-j EQUIPMENT OR MORE PROPERTY USE (Starts in CDF Direct Protection Area onIN '�V-DOMESTIC ❑ RANCH -FARM ❑ DUMP ❑ ROAD " f ❑ UTILITY, RAILROAD - ❑ UTILITY. ELECT ❑ UTILITY, OTHER ❑ FOREST INDUSTRY ❑ RECREATION _'.._... .:Q OTHER INDUSTRY -COMM . ❑ V`(ILDLAND _ --❑ NON WILDLAND ` '.'_..'a:•. VDAMAGE (CDF Direct Protection Area"only) 7 ?-IMBER WOR YOUNG GROWTH WILDLAND VEGETATION I t kept T:•nber 8 Young Growth) AGRICULTURAL PRODUCTS _ I ;Except Timber & Young Growth) f i-AVELLING &/OR CONTENTS S ,RUCTURES WOR CONTENTS ! VEHICLES & CONTENTS f OTHER «,,....... STATUT. ^ C.D.F: D.P.A."" '�' RESP. ._ . VEG. �� C.D.F. D.PA: `:'•;; TYPE .ACRES BURNEt7 TIMBER -. _.......__;... WOOD ,.. LAND BRUSH GRASS y,I OTHER PROD TOTAL ...'.. ,t. STATUT. ^ C.D.F: D.P.A."" '�' RESP. OF_ . ACRES BURNED :;`. ........... STATEU. S.F.S -. _.......__;... B.L.M. y,I OTHER FED OTHER ...'.. ,t. TOTAL • r. - ,S 3DAMAGE $ 00. 00. 00. 00. 00. 00. _.. 00. $ �O ,O 00. jj 1� V> � Uro Arj!AI V AL'• j;, up- utrec[ t'rotecvon Area only)• --1--,:-:-,,-,--- ^? ❑ VEGETATION FIRE ❑ ,OTHER (GO TO SIZE DISTANCE (Originto AC3 FEET WEATHER (Est. at scene) WIND DIRECTION FROM TEMPERATUR�Y i0 , Over please ' C. D. F. 7540-130--0118