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HomeMy WebLinkAbout078-380-010--OIo DANIEL NCRTON j'�,Q V197 - ak-,Knoll-�Wa'y;r#Orov •filler. _�_ _.. 2586..0 ser' permit#761-87E(replace-fire damaged" SF) _ a nV p _ ._-__: _. _ , _.�= ___�... _ _ __.._ -_, . _. ,.e.� __.r._ ._c .—_ T.�—_,..T-,r --=-•mac-.�=.. �. � -- a _= k _—-_�—_�.�� -f . �_— —_� .--:- _'— ice. �- .—_-� _ .__ —= __ _.--. -. _._- �.__... _...--� _ V i r - — I raft"I a i M a III O �.. { ..Y".: — � , .+..,�,`�. u•^.^�+.....x': .'v.c•-..ra c •. - vt .. •rr v •...� ..--f..T 7-- o,.,..r...�. rw qt•Y ; a x y -parse I Uo e44 OFFICE COPY 9; Address G A .r Me y Date ELECTRIC p Meter By �' Date r ... +-. ... .. _ ., J.S. . _ .. . .- .. .. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER =ELEPHONE SO. FT. OCC. BUILDING VALUATION MAILING ADDRESS - OWNER'S DD i Me CONTRACTOR• S NAME 1• .r' ELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER '//-I "Energy LICENSE NO. Plan Checking Fee $ Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS �.,< l.�ll J'�► Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF R Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W IO.00 ea TYPE OF WORK New❑ Addition❑,Remo++del❑ Utilities [:3 Installation❑ Other 1( Describe work: jt ,^ r fn.0 OC if , KF / �I> ��^ !i •'i -"I '�; y_ I� • �, , , �� �� { Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 �' ... Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F -1I am licensed under provisions of Chapt. 9, Div. 3 of the BuSIneSS and Professions Code and my license is in full force and effect. License No. Classification F71 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) ❑ I am exempt under Sec. , Business and Professions Code for this reason DWELLING OCCUP.1k) '/zQsgft NEW OR ADDNS. CONST. ` ( ACC. BLDGS. / NEW CONSTR. U TI -OUTLET 2,50 ea NO N.RESID BRANCH CIRCUITS) POWER APPARATUS &) SINGLE OUTLET CIR. Ex. OCcu zo a 50e Occup(OUTLETS OR FIXTURES eAL030 Ex. Occup. OUTLETS ED P(RESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 r If 1 r r Permit Fee j' $ S/ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ 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. ❑X 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. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor 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 County of Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence _of_the .granting of this permit. �lrz'� *� ' Date 31er�—� `' 7 Signature of Applicant'— Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3Jstories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ i occuP. CONST.TYPE __T_vLO OO PARCEL I Po ND ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. !0 -- I WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 �'. APPLICATION AND PERMIT PERMIT NO. ASSESSOR AR'CEL �J�IM ER ZONING BUILDING PERMIT OWNER `// TELEPHO E SO. FT. OCC. BUILDING VALUATION OWNER'S A LIN D ESS CON A TOR*S_NAmE TE PHONE CO RACT 'S MAILING ADDRESS Fireplace CONST (3 UCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ A CHI ECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee PLUMBING PERMIT Filing Fee 10.00 Each Trap 2,00 Solar or heat pump water heater20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5,00 1 USE OF STRUCTURE SFJJ Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S I G JW I 10 00e TYPE OF WORK New ❑ Addition ❑ Rem del ❑ Utilj -es ❑ Insta tion❑ ,4 0th Describe work: r� tIf Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main serviceOOV OR Q0000 AMP ORLESS10.00 (9 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): E]NON•R I am licensed under provisions of Chapt. 9, Div. 3 of the BUSIneS$ and Professions Code and my license is in full force and effect. License No. Classification 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) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.91 ,/z¢sgft OR ACDNS. ACC. BLDGS. NEW CONSTR ULTI.OUTLET SID BRANCH CIRCITS 2.50 ea _S,., POWER APPARATUS &) SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 200806 BAL030 FIXED APPLNS. OR EX. OCCUp. OUTLETS (RESID.) EA.; 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Mi Wiring g 15.00 Q Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ 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 Filing Fee 10.00 Heating Cooling g Hood 3,00 Ventilation Permit Fee $ Contractor 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. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue a t said County in consequ�a a of the granting of this permit. 12�® c/ �!—� Date % Signature of Applicant — Owner❑ Contractor ❑ Agent ❑ An OSHA permit 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 I I FLOOD PARCEL P13 I ND I Is uE This permit is hereby issued under sions the Butte C unty Code and/or wor in icate 1abo�e for which REC OR'6� PUBLIC 01 BY PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS o Receipt No. WNITC-D.P.W.. YELLOW-ASSC9 OR. PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTM\PM1 PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville. Californi- lephone 916/534-4541 APPLICATION AN ASSESSOR PARCEL ►J IJ MER` // / ZONING BUILDING PERMIT OWNER JD t, TELEPHO E , FT. OCC. BUILDING VALUATION � OWNER'S MA LIN ESS , () CONTRA TORS 4M n - TE PHONE CO RACT R'S MAILING ADDRESS - Fireplace CONSTi UCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee A CHI ECT'OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 t Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAMEPARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF 7"" Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W 10.00 ea. TYPE OF WORK New ❑ Addition ❑ ,1 Rem del ❑ Util' ies ❑ Insta r' tion❑ 0th �] Describe work: / - - i 'ZZ_ r� - ' Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6101 OR LESS AMP OR LESS 10.00 0100 Main service EA. ADD -L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penaltyof perjury y (Check One): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license' I$ In full force and effect. License No. Classification 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.61\ y2¢sQft OR ADDNS. ACC. BLDGS. I NEW CONSTR. UL LOUT LET NON-RESID BRANCH CIRC ITS 2.50 ea (POWER APPARATUS &) \SINGLE OUTLET CIR. Ex. OCcup�OUTLETS OR FIXTURES 2005Ot BAL@3o FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.� 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Mi . Wiring 15.00 Yf t- Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ 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 I o 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. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation Penult Fee $ Contractor 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. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue a t said County in consequ a of the granting of this permit. � Date _✓�� , Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct. ion of structures over3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ Occup. CONST.TYPC I PLOOD PARCEL PO No IS ue This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC BY PERMIT EXPIRES Date the applicable resolutions to to do do fees have been paid. WORKS Date Receipt No. ` 5 WHITE-D.P.W.. YELLOW-A3eC7 OR, PINK -INSPECTOR, GOLDENROO-APPLICANT OAC � COUNTY OF BUTTE - DEPARTMENT:OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/534-4541 PERMIT APPLICATION DATA SHEET Permit No. OWNER 001e O t^ ! A. P. N o. Proposed Building Use PCI Building Inspector Date (� At time of permit application, I was advised the following data must be submitted prior to permit processing and:/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted. . . . . . . . . . . . 2. Plot plans in duplicate./triplicate, signed by preparer of plans. 3. Complete plans in duplicate. /triplicate, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans. 5. Plans with Energy Design Compliance Statement. . . . . . 6. CUSD "Fees Paid'' Stamp on Floor Plan . . . . . . . . ` 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ , . , , , , , 9. Letter of signature authorization. . . . . . . . . . . 10. Sanitation approval from Health Dept. . . 11. Planning approval for (A) Use: (B) Parking: . 12. Certificate of Workmen's Compensation Insurance. . . . . . 13. Contractor's License Information (no., name style, classif.) • 14. Owner -Builder Verification (Given to owner, Mail to owner ❑), —15. Improvements may be required. . . . . , , , , , , 16 Mobilehome Installation Data. tJ �p l`Ct • "io �uwPre-Inspec. reque '-G�'07 (Date) 7. Pre -Inspection for rclired. Building Inspector 18. Recorded copy of Agricultural Acknowledgmentement. 19. Driveway Permit. 20. Plot plan approval from city of 21. 22. When you issue the permit, process as follows: Mail to owner, Mail to contractor. Telephone and hold folpickup at—off ice, Deliver w/inspector,. Other Applicant��`''"P`e 8 Copy of plans sent Health Dept,, Fire Dept., Other Date The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by_phone---nail—counter by date Contractor, designer, owner, was advised of above required data by—phone _mall—counter by date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder — Flours: 10:00 a.m. - 3:00 p.m. Copy—DPW COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property'Owner: An ':owner -builder" building permit has been applied for in your name and bearing your. signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit: No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement yes or no) . r 2. I(have ave not) signed an application for a building permit for proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No, 4. I plan to provide portions of this work; but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work.but I have contracted (hired) the following persons to provide the work indicated: Name Address . Phone Type of Work Signed: 'Property Owner Social' Secu ity gimber/ Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. ar Go( t4TY OF DU rTr NG DER NUMBER 22 v PUf3LIC>n(QRKS � NCIDENT NO. START MO. DAT � YEAR �• =COU 919870 6 0 _ O _ o �T R ER FIRE NAME% aI ® thru 1 Q , �.t� FC -18 (3/88). 2 ORIGIN LOCATION SEC. TOWNSHIP N . RANGE '11�, E MILES DIRECTION FROM ❑ IN. NATIONAL FOREST; FIRE DIST., CITY 8 STREET NO., �1. ❑ s _ � ❑ W i _ I S f p,Zoy/LL19 E . '� %L✓Va�. w�4Y Gly 3 INCIDENT 'TYPE �1 ACRES OF= VEGETATION'BURNED BURNED .l I . FIRE '❑ FALSE ALARM --GO TO BLOCK 10 i::xz>;: }:hkk• :, z x e �<} ` :f•,;r.,}:, < .``?':.#: .`:2f,:<� ~kr ty 3 Y: DIRECT: s #%:>. s•:�<#>s<s!%,::a<:" AGENCY' PROTECTION 8s<" RESPONSIBILITY ! _ ACRES BURNED�� G I ACRES BURNED rJ2 48 "nPSTATE ZONE STATUTORYCDF"TIMBER❑ WILDLANDBURNED OR THREATENED , RESPONSIBILITY CDF LOCAL GOVT. CONTRACT # ' S + ' # 3 WOOD (l0 AT ORIGIN) O ❑UNPROTECTED STATE OTHER }' LAND. 0 ❑ ASSIST OTHER AGENCY (Nat 4Ciy)' ❑' f > f t r ❑ U.S.F.S. ..l) BRUSH l LOCAL ZONE , • roTAt+ ❑ B.L.M. i at lei r r O ❑ CDF LOCAL GOVT: CONTRACT » '<;'aE;j �< %y s `:r.:.:; ,f- GRASS I ❑ B.I.A. ' '^•'•'� J.s :::sf�, :. ��/" 0 C] ASSIST OTHER AGENCY. (Not'City)s}4^::•<¢%.s%:%:y{!c;O. AGRIC. I ❑OTHER FEDERAL %?>E?'&' ?ic#:,;•'sx' °`,•:h!`2. t FEDERAL ZONE ; I '?� :� 6 PROD. © ❑ ASSIST FED. AGENCY (Not Mil.) j { p❑ OTHERIi CDF O ❑ CDF -LOCAL' GOVT: CONTRACT ` SIZE CL'ASS' h•%mss TOTAL + �r • , �:1 •I � + h'f �: /tai i> AMSC. AND OTHER q i. 0 _ ❑ ASSIST CITY, CONTRACT CO." MLI, OTHER y C ❑r A .25 ACRE OR JESS STATUT: I; 1 ' B 26 -9' ACRES " ; . �� '< OF PON. Oj ACRES BUF r; CAUSE (STARTS ,IN` O 2. 0 OR 8 ON �• 5 10-99 ACRES'. STATE'' L] LIGHTNING � ❑ DEBRIS '� ❑PLAY ,W/FIRE ❑ r CAMPFIRE ``- - ❑ARSON OTHER MISC. ` l r t " ( . / ❑ D 100-299,ACRES. SMOKING EQUIPMENT ❑ E 300-999 ACRES" 6 LAND 'USE (STARTS IN 1 2 5 OR 8 ONLY) ❑ F 1000-4999^ACRES �; ;B.I A. DOMESTIC❑ FOREST INDUSTRY .> ❑ G 5000 ACRES ORr MORE B.O.R.- RANCH FARM;- ❑ RECREATION ' '-' ` OTHER• ❑ DUMP ❑ OTHER. INDUSTRY-COMRCL. ;:>::.:.;!`: ?>:::# :`%##> { ;^::E}%y?;};k ?s FED. I . iy:)C;';:;`.:kti`;k�ti-- ❑ ROAD ❑ WILDLAND c%:;:::o::::::.:;zxy<:::•::}:!}.:.fyy,.:=:ate , t = `'�'•^%::%;::ftir#::k;;:•}:;v: ','k kc`{�} ;�". OTHER + Cl UTILITY, RAILROAD ❑ NON-WILDLAND j:;FJ:J,<f•`},#ir;;.}:;.}frrk,;:;f C::•!.�,:i;}•.;::.'' }$ ` .. #C,t� ❑UTILTTY, (ELECTRIC OTHER,,' ----i f .. �„ ., , r ;',;':'.;r.'.:';;z;• r• ifrz k 4x t ,i44!:r.::;,;;;.::•..kt:s}i:s:...::i::.:.!.n.r`•'F:;�y.`',.��i,hjs.'��•`,!,•:''``...�r>.':. ; k•�f !� a � TOT:AL' , i'. r itt#:?:'•:::;t::k'•~r°r:b?4'<:yfi:`':;+r#a•,',:":.'•..:,;wk, ww„ww !:•ti;'}.k:•or. <`r. •c::`.c?•r:r +•'}•,2,•.,}t.. ,:h f•si: ,i'` . :fjj'•;+,r'y.::pu,..'rl�:,::: ..'•:•`N;.'>;�:t:'i.tr,.!;:; .gin..•......... n.:.,..h... .. x» h{ !:.. .,: .:.: r::. /. } ..., n DAMAGE' r n n n n 7 Number s DA MAce, R ' .1 to,Nwma 31 TIMBER 8/ORi k' �!:` k••''k: `:`•"Z'' YOUNG GROWTH. WILDLAND VEGETATION` Other than T &'Y G •'s;"•:,:��``:;sn 4\. AGRICULTURAL PROD (Other than -T IL Y G) DWELLINGS _ C I 1000 8/OR CONTENTS OTHER STRUCTURES 3 8/OR CONTENTS VEHICLES III CONTENTS OTHER; +i f: `,'TOTALS z� � z S boo ON ARRIVAL i3O VEGETATION?FIRES ONLY) 9 SIZE i• DISTANCE (Origin to head) • 'r,j ACRES FEET WEATHER ESTIMATE AT SCENE` :• `..:I 4 - WIND SPEED,(M.P.H.) DIRECTION (FROM) TEMPERATURE (°F) 10 OVER PLEASE ' •CDF7540-130-0118 ^ j f 86 39852 t t--% ORDEW NUMBER REG. R.U. INCIDENT -NO. YEAR .2 1 -0 -9 7 nwQr. Dannon i ..,. . . DATE TIME' ' 117START7ED FEnter OUTSIDEO 2 O 8 1ST. CD Dispatch j 'AIRCRAFT FLT. HRS. CDF STATE d LOCAL GOVT. CONTRACT,., CREW NAME INSIDE 2 S OR 8 PERSON AIRCRAFT FLT. HRS. FIRE DISCOVERED 2& sr P_N F � FzbY-- . LIQ.BOX D v . ! ,b £ OF FIRST REPORT -0-31SII SECOND REPORT FIRST ATTACK BY CDF FIRE CONTAINED 3 0-3,Z0 /_77%. CREW /OVERHEAD RFC!nRn GO TO 12 x i 7 s .r 4—' LOOKOUT: If 1ST. or,2NDt made b Lookout SITE NAME: SITE NAME: c tc CDF STATE d LOCAL GOVT. CONTRACT CREW NAME ORGAN- IZATION PERSON HOURS 'AIRCRAFT FLT. HRS. CDF STATE d LOCAL GOVT. CONTRACT,., CREW NAME ORGAN- IZATIONHOURS PERSON AIRCRAFT FLT. HRS. 1 ST. ATK CDF CREW eeliq 2& sr P_N F � FzbY-- . LIQ.BOX D v . ! ,b £ OF V f L�D/.v j 1 f CDF OVERHEAD TOTAL ON 1 2 5 8 FIRES, ENTER • TOTALS BELOW �h \;'v'�i .:y; ��``w,� g?w„<z;�>.;;..� •ti"'f?4"•. a.. .�:::�c:%s:?:: ” � • .:.{,<• : •u{>�..; '''*�• :'.ii•'n $f••'+}. ..:J'41i :•`••`••�,��°�:z��?{# , U.S.F.S. (Incl. Overhead) TOTAL OTHER FEDERAL (Incl. Overhead) TOTAL ;•.,t.,' FIRE DIST. d OTHER LOCAL TOTAL ^'<^•"�"`' ' PAID HOURLY (E.F.F.) TOTALLL :" •, a44 VOLUNTEERS (Unpaid) TOTAL 3 ❑ FC -18B (Additional crew activity) ATTACHED r\ COMMENTS I srs MAP IS: k ONE SECTION ❑ FOUR SECTIONS ❑MAP ATTACHED HAOE wtiEk /t 1>+IVI EL T Y: �5' D �i1J01G:' ©k0 VI L L Z ICA 9S`f d 2& sr P_N F � FzbY-- . LIQ.BOX D v . ! ,b £ OF V f L�D/.v IRW r1 ORIGINAL REPORT BY: } APPROVED BY: v SIG TURE /-+ r TITLE INT(.n DATE/ m