HomeMy WebLinkAbout024-290-011r
AP -29-11
BILL PEARSALL
n/s Hol Ii81. ane, 1000?. T. of Hwy 99,
lot 11, Gridley
' B P E M(new
_ . Permit## 3 9-75_ , , _, ,
AP .24. -29 -ll
Permit 3525-75E (s) �s
(add' 1 elec. for 3149-75
24-29-1r1 884-89B,P,E
TADE, John
81 Hollis lane., Gridley
Contr: John Cooper
(repair fire,damage)SF
FINALED :
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AP -29-11
BILL PEARSALL
n/s Hol Ii81. ane, 1000?. T. of Hwy 99,
lot 11, Gridley
' B P E M(new
_ . Permit## 3 9-75_ , , _, ,
AP .24. -29 -ll
Permit 3525-75E (s) �s
(add' 1 elec. for 3149-75
24-29-1r1 884-89B,P,E
TADE, John
81 Hollis lane., Gridley
Contr: John Cooper
(repair fire,damage)SF
FINALED :
a
"!PERMIT No. �3149-75BP,E,M
P
1'
E
,r M
4MH UTIL.
j`PERMIT NO.
o IS
PERMIT EXPIRES
DOWNER Bill Pearsall
I'CONTR.
OCATION (A.P. 24-29-11 )
n/s Hollis Lane, 1000' E.of Hwy 99, lot 11,
¢a; - Gridley
j' Temp. Power A�e
Called PG&E
Temp. Elec. Serv.
Called PG&E
Temp. Gas Serv.
Called PG&E e -7 —
T JOB
FINALED
if
( ate)
(Signature)
z
COUNTY OF BUTTE DEPARTMENT OF PUBLIC -WORKS
BUILDING INSPECTION RECORD
BUILDING BUILDING (Cont'd) PLUMBING
Setback J Firewal Soil Piping
OL -
Forms Parapets 1st Floor "Ap7
Main B dg. Restroom Finish 2nd Floor
Footings Windows 3rd Floor
Stemwall S i d i n a To out ef�- ��—
Slab Roof Sheathino Water Piping 1;. 7
Piers Roofing Sew
Garage Fdn. Vents Fixtures fh�
Footings Garage Vents Water Htr.
Stemwall Prov. for physically Heaters
Slab handicapped Appliances
Carport Conformance of ex. Gas Piping & Te .,t?-
Footin s structure Temp. Gas
Slab Final % Sanitation
Patio FIREPLACE Final ,2.3 7
Footings Footing LECTRICAL
Masonry Walls Throat Rou h 5—.--
Reinf. Steel Final Fixture
Bond Beam FIRE SPRINKLERS Motors
Framin Test Water Htr �t �
Stucco Final Sub anelsx_
Mesh MECHANICAL Grd. Fault Prot.
Scratch 6 J --j, ' Heating Service
Brown Cooling Temp. Role
Finis -7 Ducts Under •round
Interior Lath Ventilation Permanent
Door Closer Final Fina °7 �—
DATE REMARKS OR CORRECTIONS
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Cgnter Drive — Oroville, California 95965 35�Wj ��
Telephone: 534-4541 �.
APPLICATION AND PERMIT* 1�
'
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
��one�lo..
`"
Fireplace
Contractor
Total Valuation -
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.,
Permit Fee
Building Address
'
-PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
G'
Each Trap 1.50
,.
Repair drainage or vent piping 1.50
Water piping 4 1.50
'
Each gas, water heater or vent 1.50
( ,
A. P. No. '7 CSC ��
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
_60"484M
Fire Dept.
Fire Zone
Use Permit
Building sewer_ 5.00
EQA
Parking
Plans
Parcel
Declaration
P
60'.R/W
Im rovements
p
Lawn sprinkler system 2.00,
one ec
Parcel Approval
Plans Approval
Permit Fee $
$
NEW ADDITION ❑ UTILITIES ❑ OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00 8,00
Main service incl, 1 meter
7
Additional meters, each 1.00
Sub -panel (12 or less) (morethan 12)
_
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Range, Cook -top or Oven 1.00 -
Water Heater or Space Heater 1.00
Light fixtures` b �2
f
Receps„ switches & fix outlets
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:
Hood, Ex. Fan or F.A. Furri. Motor 1.00
Evap. cool er, gar. di sp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
lassification•❑
License No. Classification-
Misc. wiring a
E]I am exempt from the Contractors License Laws of the State of Cal ifomia.
Permit Fee ' $
$44 1 a
MECHANICAL No. @ FEE
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-Vthave placed on file with the County of Butte a certificate of
\Workmen's Compensation Insurance.
certify that in the performance of the work for which this
❑ piermit ,is issued I shall not employ any person in any manner .
so as to become subject to the Workmen's,Compensation Laws of,
California.
PERMIT FILING FEE $3.00
Heating
Cooling• '
Ventilation
Hood'• 2.00
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 relating to building construction, and hereby"
TOTAL PERMIT FEE
$
autnonce representatives or ine vounty or tsutte to enter upon tner
above-mentioned property.for inspection purposes. �•
Signature of'Permi'tee 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 Butte County Code and/or resolutions to do work indicated
above for which fees have been paid..
DIRE T R OF PUBLIC WORKS
BY Date
r Building permit ��
COUNTY OF BUTTE —)-DEPARTMENT OF PUBLIC WORK%L 9� j
7 County Center Drive — Oroville, California 95965 / lJ
Telephone: 534-4541
APPLICATION AND PERMIT G�
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
xat"
Signature of )Pe� A4
gent
Receipt No. / 3 7 ; ?
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 p 'd.
DIRECTOR OF BLIC WORK7--7—
i
S7
By Date /"%- 7 /�
ilding permit expires Date 7'�7 -71�
BUILD i, G_
Owner SAIL
SO. FT. OCC. BUILDING VALUATION
Mailing Address 1SbZ
U"'^' /-rnN
Fireplace
Contractor
Total Valuation
Mailing Address
Telephone No.
Permit Fee
Plan Checking Fee &/or Penalty
Permit Fee
Building Address N E
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00 ,DQ
L Y
Each Trap 1.50 9,00
Repair drainage or vent piping 1,50
Water piping j 1.50 ).S401
Each gas water heater or vent 1.50
A. P. No.
Zoning & Planning
Gas piping system 1 - 5 outlets / 1.50
Each additional outlet .30
Fees
W. C. Sa o
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking Parcel
Plans I Declaration
parcel Ma 60' R/W
P
Im rovemen
P
Lawn sprinkler system 2.00
Re
Parcel Avovol
Plans Aproval
Permit Fee $
$
ADDITION ❑ UTILITIES ❑ OTHER ❑
ELECTRICAL No. @ FEE
PERMIT FILING FEE --1$3.00 ,O v
Main service incl. 1 meter 3,00
Additional meters, each 1.00
Sub -panel (12 or`f>fs) (more than 12) i Q
-
Single Family LK Duplex ❑ Mobil Home ❑ Others'[]
Range!Cook-top or Oven / 1.00 ,Q
Water Up-ater or Space Heater 1.00
%2 2 ZS
Light fixtures b 10
Re s., swit &fix qlets S40
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: _
Ho x. FaM r:F.A. Furn. Motor 1.00
Evap. cooler, gar. disp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
License No.,z®z,/6 Classification
Misc. wiring
❑ I am exempt from the Contractors License Laws of the State of Cal ifomia.
Permit Fee $
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.
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 ,Q Q
Heating OtJ
Cooling
Ventilation
Hood 2.00 ,Q Q
Permit Fee $
$ QZ
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
TOTAL PERMIT FEE
$lc
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
xat"
Signature of )Pe� A4
gent
Receipt No. / 3 7 ; ?
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 p 'd.
DIRECTOR OF BLIC WORK7--7—
i
S7
By Date /"%- 7 /�
ilding permit expires Date 7'�7 -71�
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT REGULA-
TIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 25, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
Street Lot Number Tract No.
EXTERIOR WALLS
�- Thickness T `'L R Valu
Manufacture J/Type
to,
Batts: Manufactur&2r / ,L/Z Thickness R Value_
Blown: Manufacturer Thickness No. Bags ' Wt./Bag
Sq. Ft. Covered R Value
FLOORS
Manufacturer Thickness/Type R Value
SLAB ON GRADE
Manufacturer Thickness/Type R Value
Width of Insulation inches
FOUNDATION WALLS
ManufacturerThickness/Type R Value
GENERAL CONTRALTO �r��r-��-�-�0 LICENSE No.�
BY TITLE — DATE
INSULATION CONTRACTOR' HAWKINS INSULATION CO. LICENSE No. 215-925
BYZ! � 1:� TITLE G�li�-�v DA
Ill O -N. -
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS P M T NO��,
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 <`
APPLICA71ON AND PERMIT
AS ESSOR PARCEL % MBER r.
NBUILDING
i.
ZON17
111
PERMIT
OWN R .*���''
N !o e
TEL PH NE
Q. FT. OCC. BUILDING VALUATION
OWFJ MAIWG A RESS t
0 %' n ' r' 9
CON C OR'S NAM
T EPH
CON R C OR'S MA SLING DRES +^
y
Fireplace
CONSTRUCTION LENDER'
UNKNOWN
Total Valuation $
'
LENDER'S MAILING ADDRESS i
Filing Fee
$ -10.00
Permit Fee
$ ()
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
,$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS aisPermit
fee
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
1 1 2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL 7AP
I
Water piping
5.00 00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF X Duplex❑ Mobilehome❑ Other i
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
0.00 ea -
TYPE OF WORK
New ❑ Addition Remodel ❑ Uti litie El Installation 'Other (�
/
Describe work: ( GI QCT
i
7 I� -< 1 � - V1 i
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
yYl I C
0- 01Main
Main service 100 AMP OV OR R LESS
10.00
service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW r
I deClar nder penalty of perjury (check one):
1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code! �anndf my license is in full force and effect.
License No. -S j •] y ` "� Classification !_?
El 1, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed! contract-
ors. (Sec. 7044) y
❑ I am exempt under Sec. , Business and Professions Code
for this -reason I
NEW CONST. DWELLING OCCUP.51,
OR ADDNS. ACC. BLDGS. /22Sq ft
NEW CONSTR U TI•oUTLET 2,50 ea
NON.RESID .BRANCH CIRC ITS
POWER APPARATUS 6
(SINGLE OUTLET CIR.
Ex. OCcup(OUTLETS OR FIXTURES eA 090
EX. Occup. OUTLETS (RESID )REA.FIXED APPLNS. I 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc.IYirin g 15.00 15,00
Permit Fee $
`WORKMEN'S COMPENSATION- INSURANCE
I declare under penalty of perjury'* (check one):
n The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to. Self -Insure..
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement,should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shal I be deemed revoked.
Contractor
MECHANICAL PERMIT
FiIingFee 10.00
Heating
r
Cooling
g
Hood
3.00
Ventilation
permit Fee
$
Contractor r
1 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 Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I al.5o af`'gtr4erto save, indemnify and keep harmless the County of Butte against
all�fi HU s, l'upgments, costs, and expenses which may in any way accrue
again sat Co�u/r�ty in consequence of the granting of this permit.
X Date l� �C) - U�
Signature of Applicant — Owner El Contractor ❑ Agent ❑
An OSHA pe mit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy_ Inspection Fee $
TOTAL PERMIT FEE I $
OCCUP.
CONST7PEJ
SCHOOL
FLOOD
PARCEL
HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work irtdi.Cated above for which
l
DIRE OF PU
y
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
f s have been aid.
P
L WORKS
Da t
Receipt No.
WHIT[-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICOONAD PERMIT
NO.
AS ESSOR PA CEL y MB ER
ZONI
BUILDING PERMIT
owN r
TELEPHONE
OCC.1 BUILDING VALUATION
OW MAIL G A RESS
% o /, rIta
CONO 'S NAM J
T EPN
CON RAG R S MA ING RES
Y
Fireplace
CON RUCTION LENDEW
VNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ Q
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
.$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS 21 Ln
Permit fee
$ V0.
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2,00
`
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL tP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF Z Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
O.00ea
TYPE OF WORK
New ❑ Addition Remodel ❑ Uti litie Installatio 0 her �1�
Des ribe work: Gi QC`
4LECTRICAL
Permit Fee
S
actor
PERMIT
rMain
Filing Fee 10.00
`C'
8001 OR LESS
service 100 AMP OR LESS
10.00
service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I de lar der penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
f (
License No. O ` v Classification
❑EX.
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.01 ,/20sgft
OR ADDNS. ( ACC. BLDGS.
NEW CONSTFL U TI -OUTLET
NON.RESID BRANCH CIRCUITS) 2.50 ea
POWER APPARATUS a
(SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES 15AL0 3 30
OCCUp. OUTLETS FIXED P(RESID )LNS REA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00 o
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
n—The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement,should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Cooling
g
Hood
3.00
Ventilation
penult Fee-.
$
Contractor,
I certify that I have read this application and state that the above information
1s correct. I agree to comply to all County Ordinances and State Laws relating
to building co truction, and hereby authorize representatives of the County of
Butte to ent u n the above-mentioned property for inspection purposes.
1 o g to )sve, indemnify and keep harmless the County of Butte against
I ilitl s, gments, costs, and expenses which may in any way accrue
aga sai Coy in consequence of the granting of this permit.
-�'3V _ �j�
X Date
Applicant — Owner ❑ Contractor ❑ Agent ❑
Signature �Im
An OSHAit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE _
OcCuP.
CONST.TYPc
SCHOOLFLOODPARCELal
This permit is hereby issued under
sions of the Butte County Code and/or
work i ' ated above for which
DIRE F PU
y
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
f s have been paid.
WORKS
t�1,149A�9
Receipt No.
WNITE-O.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
R% E mr , %1f . j%.j R' 7
FC -18 (3/86)
ORIGIN LOCATION
-.4
ORDER NUMBER'.
REG. R.U. 1,11sl6tEN—rNO." START MO. DATE YEAR COUNTY
I .. I '? 3`1- 0 a - Q 3 _S -?'oy
FIRE NUMBER FIRE NAME:
MG. A.U. NO. firu
a
j"
SEC. �C
0 (
TOWNSHIP[S N
— — El s
RANGE
E
0 3 1:1
"-MILES_
DIRECTION
FROM'. IN*.-
l5ri1 - 7 1/
NATIONAL FOREST, FIRE DIST., CITY & STREET NO.,
ETC. _60a '
Ley, C.4,
NUMber(R-
E
INCIE] DENT TYPE ACRES -OF VEGETATION BURNED
3
FIRE ❑ FALSE ALARM—GO TO
"'
BLOCK 10 0
DIRECT
AGENCY PROTECTION
ACRES BURNED ACRES BURNED
RESPONSIBILITY VEG.
4A 48 STATE ZONE STATU C . DF
TIMBER
WILDLAND'BURNED OR THREATENED RESPONSIBILITY
CDF LOCAL GOVT. CONTRACT AT ORIGIN)" WOOD WOOD
.0 UNPROTECTED ❑ STATE OTHER
'ASSIST OTHER AGENCY (Not City) k BRUSH
0 U.S.F.S.
TOTAL
LOCAL ZONE ❑
BA.M.
CDF LOCAL GOVT. CONTRACT ❑ B.1 -A. UKAW)
..... . ... ...
m %
AGRIC.
ASSIST OTHER AGENCY Not Cirty) Ej OTHER FEDERAL I
PROD.
-FEDERAL ZONE -E]'-OTHER�� 813 .....
❑ ASSIST FED. AGENCY (Not Mi.)
CDF LOCAL GOVT. CONTRACT 5SIZE CLASS TOTAL
. . . . . . . . . . . . . . . ...
MISC. AND OTHER 8D.. % X ROME'
0
9 ❑ ❑
ASSIST CITY, CONTRACT CO., MIL, OTHER'ACRE OR LESS
STATUT..
REWOk. 1 ACRES BURNED
8 %26 -9 ACRES
CAUSE (STARTS IN OR ONLY) OF
5 C 10-99
[3. LIGHTNING E] DEBRIS ACRES STATE
PLAY W/FIRE
0 CAMPFIRE ❑ARSON OTHER/MIS ES
�,,!00-299 ACR U.S.F.S.
6
'SMOKING EQUIPMENT
.�
E]aE 300=999ACRE.S.'..:,_--,_!�: 9 L.M
"lp
3 e -,N LAND USE (STARTS IN 1 2 5 OR V ONLY) ❑F 1000-4999 ACRES B.I.A.
'0 G 5000 ACRES OR MORE
B.O.R.
tg,DOMESTIC E] FOREST INDUSTRY - i
Ir -, j , V�. . . J-
C] RECREATION— -k-.114 11:_11. - '_ ".
OTHER
❑ DUMP .......
FED.
C] OTHER INDUSTRY-COMRCL
0
.ROAD. ❑ WILDLAND
O,UT
UTILIT Y, RAILROAD
❑'UTILITY, ELECTRIC ❑ OTHER
T
TOTAL
7t
'DAMAGE OR <s ONLY)
ON ARRIVAL 0'VE�4,,-ETAiCCiN.-FI'RE'S" O-kLY).:`
9/7tzi q DISTANCE (Odg
n to
ACRES FEET
4!!ATHER
STIMATE AT SCENE)
m
IND SPEW (MP.H.) z,, (RECTION (FROM).; -
10
.OVER PLEASE
COF 7540-130.011a
86 39852
S DAMAGE
NUMber(R-
W off t* Parse Si
1
2 &/or 8
TIMBER &/Olt-,_
YOUNG G ROWTH
WILDLAND VEGETATION
(Oflw than T & Y G)
AGRICULTURAL PROD
(Other than T &- Y G)
DWELLINGS
iris)
&/OR CONTENTS
OTHER STRUCTURES
&/OR'.CONTENTS-
VEHICLES k_C0t.4TENTS -
OTHER.-',
ON ARRIVAL 0'VE�4,,-ETAiCCiN.-FI'RE'S" O-kLY).:`
9/7tzi q DISTANCE (Odg
n to
ACRES FEET
4!!ATHER
STIMATE AT SCENE)
m
IND SPEW (MP.H.) z,, (RECTION (FROM).; -
10
.OVER PLEASE
COF 7540-130.011a
86 39852
WK-� .
�.�-fin. ��
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�'9 so 0
ef
COUNI" PSC
or VUqUr
WOWS
DEPT.
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