2. Chiniak Specific Agreement to Remove Firewood From Kodiak Island Borough Lands

   This form should be completed and printed or otherwise saved as evidence that a permit has been issued. Proof must be available while collecting firewood on the Borough's Chiniak firewood gathering site.

4. SECTION 1. LICENSE GRANTED:
   The Kodiak Island Borough (licensor), enters into this agreement with the licensee named below, to create a license.
6. SECTION 2. PURPOSE:
   This license allows the licensee to enter onto lands of the licensor to cut and remove spruce wood for PERSONAL USE ONLY.
8. SECTION 3. LICENSED PROPERTY:
   This license is ONLY good for downed trees, decked fire logs and timber slash material located within the borough-owned lands in the Chiniak Burn Timber Harvest Area
10. SECTION 4. TERM:
    The right, privilege, and license granted herein shall continue, and exist from the date this license was entered into until the date listed below.
12. SECTION 5. INDEMNIFICATION:
    The licensee shall indemnify the licensor and hold them harmless from claims for damage to property or injuries to persons, which may arise from or be incident to the use and occupation of said land under this license.
14. SECTION 6. NONTRANSFERABLE:
    This license is restricted to the licensee named below.
16. SECTION 7. CONDITIONS:*

    In addition to the items stated above, the licensee hereby agrees to the following by checking the boxes:

    1. NO CUTTING OF STANDING TIMBER OR TREES LEANING OR OTHERWISE SUSPENDED;
    2. LICENSEE SHALL HAVE THIS LICENSE AT THE SITE FOR INSPECTION;
    3. LICENSEE IS RESPONSIBLE TO ORIENT THEMSELVES SO AS TO BE ON THE PROPER PARCEL;
    4. LEISNOI LAND IS MARKED WITH SIGNAGE
20. Licensee
    I HAVE READ THE ABOVE CONDITIONS, UNDERSTAND EACH ITEM, AND AGREE TO ABIDE BY ALL CONDITIONS.
22. Name*
24. Address*
26. Phone ###-###-####*
27. Email
29. Description of vehicle used:*
30. License Plate Number*
32. Signature

    _________________________________________________

33. Date
    Date
37. Expiration

    This permit expires on December 31st of the year in which it is obtained.

39. Other Info:
    SHOULD YOU HAVE ANY QUESTIONS, OR SEE SOMEONE HARVESTING WOOD WITHOUT A PERMIT, PLEASE CONTACT THE BOROUGH AT @ 486-9304 or 486-9364
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

* indicates a required field