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Yurok Tribe Application for Field Registration

For office use only

Tracking Number: 03-FR -____________

Date Received:________________

Payment Received: ______________

Permit Approved:_______________

Permit Mailed:_________________

Comment Op/Cl:_______________

Applicant Name: _______________________


Mailing Address:____________________________________________________________

Fields applied for:

Field No.


Location (T/R/S)


Fees Due:

$XX.00 per acre x _____________



IMPORTANT: Your application for Field Registration 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 signature)



Copy as necessary – Fill out one sheet per section

Please locate and identify in the Section below: Fields to be burned, access roads, highways, houses, other sensitive areas or hazards, and include arrows to sensitive areas outside of this section. When more than one field is shown, label each field using the field number from page 1.

T: ____________________ R:________________________ Section:___________________

Field Number(s):_________________________

Primary Purpose of Burn:______________________________________________

Special Burn Considerations:____________________________________________




Alternatives Analysis:

Attach an evaluation of alternatives considered for burning activities.

Emissions Reduction:

Attach a description of emissions control measures which will be taken in this project.


Attach proof of certification congruent with YTC 21.10.310 of the Smoke Management Plan.


If required by the Smoke Management Plan, attach a detailed visual monitoring plan.