Print this form – and the Right to Enter form – and mail both to: 
Bruce Anderson   .  P.O. Box 2  .  Cobb, CA  95426  .  707-928-5232
or to:    James Ott  .  P. O. Box 942  .  Middletown, CA 95461

Request for Chipping:

Number of Piles ______     Size of Piles  W________ (x) L ________ (x) H _________

Where is the material?  County Road {   }  Driveway {   }  Other:________________

First _______________________  M.I. ___   Last______________________________

Street Address __________________________________________________________

City/Subdivision: ________________________________________________________

Nearest Cross Street_____________________________________________________ 
                                             
Assessor ’s Parcel # _____________________ Phone #_________________________

Contact Address if Different ________________________________________________

Are you the property owner?  Yes {   }  No  {   } 

Owner ’s Name ____________________________________Town__________________

I have completed the above referenced requirements.  I understand that the South Lake Fire Safe Council will make every attempt to perform the work on the scheduled date, but due to unforeseen circumstances (such as weather, equipment breakdowns, crew illness/injury or jobs taking longer than anticipated), I also understand the work may be delayed.

                                                                                                                  Signature                                                                                Date

The material must be stacked adjacent to roads and accessible to our contractor’s equipment without having to be moved. 

The material must be free of rocks, dirt, berry vines, poison oak, tree stumps or construction material of any type. 

Brush, tree limbs, and trees smaller than six inches (6”) must be stacked neatly and evenly with the butt ends all facing the road. Piles cannot exceed five feet (5’) in height. 

Bulldozed piles or machine-stacked piles cannot be processed. 

Piles cross-stacked or stacked so dense and compacted that the material cannot be pulled free to run through the chipper will not be processed. 

Material must be cut to manageable twelve foot (12’) lengths maximum. 

Do not submit this form until the material is stacked and ready for inspection.

Pre-Inspector’s Notes:

For Office Use Only 

Date Received _______  Date Entered _______  Date Inspected _______  Date Completed ________