Application

Senior/Disabled Defensible Space
Application for Service

* Indicates required field

Name *

First

Last

Address of property to receive treatment *

Mailing Address *

Qualification for service *

65+ years Disabled

Does the property have a habitable structure? *

Yes No

Phone number *

Email *

Yearly Income *

Comments *

All work through the assistance program will be accomplished by a contractor retained by Plumas Corporation for the Plumas County Fire Safe Council. The work will be completed as closely as possible to CA PRC 4291 requirements, with a per parcel cost not to exceed $1,500.

I accept that if I wish more work to be done than require by this code (beyond the 100 feet), or above the $1,500 PCFSC cap, that it must be done prior to or after this contract has ended so that work being completed by the PCFSC contractor can be inspected in a timely manner.

I accept responsibility for making PCFSC and hired contractors aware of and pets or dangers on my property and locations of property boundaries, septic tanks, leach fields, sprinkler heads or anything else that equipment may damage. I agree to the chips generated being left on my property.

I certify that the information on this form to be correct and true. All requirements in this application/contract will be followed if assistance is received from Plumas County Fire Safe Council/Plumas Corporation.

Based upon my income and the co-pay chart, I agree to pay my portion as determined by the accepted bid to Plumas Corporation for all defensible space work that is completed by PCFSC.

Submit

Senior/Disabled Defensible SpaceApplication for Service

Senior/Disabled Defensible Space
Application for Service