BURN PERMIT APPLICATION

Community and Ecosystems

Robin Blythe
Specialist
NEPA & CEQA Compliance/Environmental Education, Tribal Ordinances rblythe@yuroktribe.nsn.us
(707) 954-3342 cell
(707) 482-1822 x 1014 office

Joe Hostler
Specialist
Air Quality jhostler@yuroktribe.nsn.us
(707) 499-3811 cell
(707) 482-1822 x 1010 office

Suzanne Fluharty
Specialist
Pesticides & Environmental Health sfluharty@yuroktribe.nsn.us (707) 954-9290 cell
(707) 482-1822 x 1013 office



Yurok Tribe
Klamath Office
15900 Hwy 101 N
PO Box 1027
Klamath, CA 95548


Burn Permit Application


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Please fill out form below and submit for approval.


Applicant Name Date

Tribal ID# (if applicable) Email

Mailing Address

PARCELS APPLIED FOR:

Parcel Number Address
Parcel Number Address
Parcel Number Address
Parcel Number Address

# of parcels $50.00 per parcel Total= $

If you have completed the one-hour household burning workshop this year, please attach documentation; your documentation will be accepted instead of any fees due.


IMPORTANT: Your application for a Seasonal Domestic Burn Permit does NOT constitute permission to burn! You will receive a copy of your Permit through the mail within two weeks of receipt of your completed application and fees. Once you receive your Permit, you are expected to comply with the provisions of the Air Quality Ordinance and the Tribal Smoke Management Plan.


I agree to comply with the Tribal Air Quality Ordinance and Smoke Management Plan.

Applicant:Date:

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