Form Qq 31 – Fill Out and Use This PDF

Forest Practices Application/Notification Renewal

Exempt 20 Acre Parcels

Instructions:

You may renew your current Forest Practices Application or Notification if :

•You are not proposing to modify the uncompleted operation.

•There are no outstanding enforcement actions associated with the application/notification.

•The forest practices rules in effect at the time of renewal do not require a change in the nature and extent of the forest practice.

Fill out this form. Send the form with the appropriate fees to the department region office that is responsible for the geographic area of the operation. Type or print in permanent ink. You can find a list of DNR region offices by going to the DNR web site at http://www.dnr.wa.gov and clicking on "Regions".

Renewal requests must be received and accepted at the region office prior to the expiration date of your current forest practices application or notification.

APPLICATION NUMBER: ___________________	EXPIRATION DATE:_________________
Classification of the original forest practice: Class II - [ ]	Class III - [ ] Class IV General - [ ] Class IV Special - [ ]

Are you proposing any modifications of the original forest practices?

[ ] YES Stop. You must complete a new Forest Practice Application/ Notification Form. [ ] NO Continue.

1) Full legal name of Landowner		2) Full legal name of Timber Owner		3) Full legal name of Operator
Business		Business		Business
Contact:		Contact:		Contact:
Mailing Address		Mailing Address		Mailing Address
City, State or Province, Country, and		City, State or Province, Country, and		City, State or Province, Country, and
Zip or Postal Code		Zip or Postal Code		Zip or Postal Code
Phone (	)	Phone (	)	Phone (	)
E-Mail:		E-Mail:		E-Mail:

4) Legal description and county of the forest practice activity.

Form QQ 31 (07-22-07)

Exempt 20 Acre Application / Notification Renewal

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5)If harvesting within the Maximum RMZ widths on a 20-acre exempt parcel, complete the table below. See question 14 of the Forest Practices Application/Notification Instructions found at http://www.dnr.wa.gov/forestpractices.

a.[ ] No [ ] Yes Was this parcel 20 acres or less before June 5, 2006?

b.[ ] No [ ] Yes Have you owned less than 80 forested acres since June 4, 2006?

6)Are you harvesting within 29 feet of a Type Np water on a 20 acre exempt parcel?

[ ] No Skip to question 7.

[ ] Yes Describe leave tree strategy in the space provided or attach an additional sheet of paper. See question 15 of the Forest Practices Application/Notification Instructions found at http://www.dnr.wa.gov/forestpractices.

7)Complete the table below for either Western or Eastern Washington if harvesting within the Maximum RMZ widths. See question 15 of the Forest Practices Application/Notification Instructions found at http://www.dnr.wa.gov/forestpractices.

Western Washington:

Eastern Washington:

8)I/We affirm that the information contained herein is true, and understand that this proposed forest practice is subject to the current rules of the Forest Practices Act, as well as any applicable federal, state or local rules and regulations. Compliance with this application/notification does not ensure compliance with the Endangered Species Act, or other federal, state, or local laws.

Signature of Landowner:	Signature of Timber Owner:	Signature of Operator:
Date:	Date:	Date:
Print Landowner name:	Print Timber Owner name:	Print Operator name:

Form QQ 31 (07-22-07)

Exempt 20 Acre Application / Notification Renewal

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Agency Use Below the Line

	FPA/N #_____________________
RMS PAYMENT #_______________
	DATE RCVD:_________________
RMAP #________________
	REGION_____________________
Decision:	EFFECTIVE DATE___________________
[ ] MEETS REQUIREMENTS FOR RENEWAL	EXPIRATION DATE__________________

[] DOES NOT MEET REQUIREMENTS FOR RENEWAL [ ] Modification(s) to the uncompleted operation

[ ] Outstanding enforcement actions associated with this application / notification

[ ] The current forest practices rules require a change in the nature and extent of the forest practice.

[] Request was not received and accepted at the region office prior to the expiration date of your current forest practices application or notification.

[ ] CLOSED-OUT

CONDITIONS:

[] ALL CONDITIONS OF THE ORIGINAL APPLICATION / NOTIFICATION APPLY

[] THE FOLLOWING CONDITIONS APPLY:

___________________________________/___________________ _________________ _______________

Issued by

Title

Region

Date

Form QQ 31 (07-22-07)

Exempt 20 Acre Application / Notification Renewal

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