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FIRE DAMAGE REPORT
OWNER:/U_' &k' 0-41-M6'0
• • `% • i
CONTRACTOR:
DATE TO INSPECTOR:
Building Description:
DATE: S/ Q
A.P.#
ZONING:
PERMIT HISTORYANONE () AS FOLLOWS:
BUILDING INSPECTOR'S REPORT
Commercial/Usage:
Residential/# of Units:_
Currently Occupied
AbandonedNacant
Electric:
Yes No Electric currently On Off
Condition of Electric
Gas:
Natural Propane None Currently On Off
Obvious Problems:
Sanitation:
Plumbing Working
Well Working Potable Water__/
Obvious SewageProblems
t
s'
Description of Damaged Area:
Estimate Valuation of Damaged Area.
Condition of Foundation:
Mobile Home: Condition f Utilities: r
Inspector: - Date
Sketch building on reverse and indicate area of damage.
s
i S-
CDF/BUTTE COUNTY FIRE INCIDENT LOG
WJLWW
DATE 12/3111999 INCIDENT NUMBER 12893
REPORT TIME 1 09:04 LOCAL FIRE NUMBER 11125
STATE FIRE NUMBER 0
CASE NUMBER 0
LOCATION 11415 7TH ST
RP I HONE NUMBER 532-4N7
COUNTY NOTIFICATIONS Iii DES 1 EMD PRA
STATE WILDLAND FIRES
STATE STRUCTURE FIRES
STATE OTHER FIRE
STATE MEDICAL AIDS
STATE PSA/OTHER
STATE HAZ MAT
LOGGED BY JAMC
RO LE ICK
STATION # i63 i
MEDICS:
OFFICER B211fi
B
A9 AGENCYID BUT
LOCAL WILDLAND FIRES i I LOCAL ACRES 0
LOCAL STRUCTURE FIRES RESIDENTIAL
LOCAL OTHER FIRES
LOCAL MEDICAL AIDS
LOCAL PSA/OTHER:
LOCAL HAZ MA
INCIDENT NAME ISEVENTH START TIME: 0858 CAUSE IPLAYING WITH FIRE
LAND USE IDOMESTIC ACRES: TYPE OF ACRES:
DOLLAR DAMAGE 70001 LOCAL TYPE $ DAMAGE: JALL OTHER SAVE 1 1750000
DIAMOND #: 15.0 INJURIES/FATALITIES
# CIVILIAN INJURIES: F 01# CIVILIAN FATALITIES: O�# FF INJURIES: # FF FATALITIES 0
FC -40 DATE OF FC40 INC SEN E-MAIL STATION 63
AGENCY INC #:I INC P# 7 -DAY INITIALS jJK
COMMENTS: NBEDROOM FIRE �
11110 .11 I14tA1 KrUUKU I' LHJI LUI,ALrIKGiTi �� LHJI WAIr- rmr-g ILNJI VHJ� I 11
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