Fire Mitigation Fees

South Lake County Fire Protection District in cooperation with California Department of Forestry and Fire Protection

P.O. Box 1360 Middletown, CA 95461 - (707) 987-3089
Fire Mitigation Fees
Applicant Name*

First NameLast Name
Applicant's Telephone*
Applicant Email*
example@example.com
Applicant is*

OwnerContractorOther
Legal Owners Name, if different from Applicant Name
First and Last Name
Legal Owner's Telephone
Owner Mailing Address*

Street Address or PO Box

CityState / Province

Postal / Zip Code
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
APN*
Property Type (use comment section to provide additional information, if necessary):*

ResidentialNonresidential or other (i.e. commercial)
Project Type (use description line to provide additional information, i.e. manufactured home, metal building):*

New StructureRemodel / Addition to Existing StructureReplacementAccessory Structure
Description (use comment section to provide additional information, if not enough space)
Please provide the "under-covered roof" square footages. This includes the living area and upper level, if any, covered deck, porch, and carport, and garage.
Main Structure
Garage, Workshop
Covered Deck(s), Carport(s)
Addition, Remodel
Total Square Footage
I, the applicant, declare under penalty of perjury that the information provided is correct to the best of his/her knowledge and understands additional fees may apply should there be additional development to above project address or should the square footage be more than provided.
Applicants Signature

Clear
Date

MonthDayYear
Date
Additional Applicant Comments, if necessary (i.e. Permit R-25-135)

30 word limit0/30
Should be Empty: