Woodsmoke Reduction Program Form - Hibernation

New device to be installed *Choose the type of new device you'd like installed to replace your current one. EPA-certified devices must be catalytic, hybrid, or on a list of SELECT non-catalytic models.EPA Certified Stove (Wood or Pellet)EPA Certified Fireplace Insert (Wood or Pellet)Electric (Not available from Hibernation)

Incentive Requested *Select whether you're applying for the standard or enhanced voucher.Standard Incentive - $1500Enhanced Incentive - $5000

Enhanced Voucher Eligibility Requirements

Enhanced Voucher Qualifications

You can get up to $5,000 if you meet just one of these three requirements:

Living in a Low Income or Disadvantaged Community
Use this map to see if your address is in one of these communities:
Check Address (Opens in New Window)
Please come back to this page after checking your address so you can finish the application.
Participation in a Low Income Assistance Program
Examples include WIC, CARE, LIHEAP, and SNAP (or any other program that helps with your bills).
You may be asked to show proof, like a recent letter or statement.

Your Household Income Is at or Below 80% of the County's Median
If you’re not sure, see the table below. If your income is at or under the number for your household size, you qualify.

Household Size	Max Income
1 Person	$39,000
2 People	$44,600
3 People	$50,150
4 People	$55,700
5 People	$60,200
6 People	$64,650
7 People	$69,100
8 People	$73,550

If your home has more than 8 people, call us for more details.

Note: You only need to meet one of these. Please have proof ready for whichever option you choose.

Enhanced Incentive - Choose one of the following options *I live in a Low Income or Disadvantaged CommunityProof of participation in a federal or state income assistance program (WIC, CARE, LIHEAP)My household income is less than 80% of county median. Contact District for details.

How did you hear about the program? *0 / 100

Is the voucher a significant factor in replacing your stove? *YesNo

Why are you applying? *Please check all that apply.I am not satisfied with the existing deviceI want to reduce pollutionI want to save moneyOther

Other *

In a typical season, how many cords of wood do you burn? *

Agreements *Please read each statement carefully. By checking each box, you confirm that you agree with that statement. These agreements must be confirmed to complete your application.The residence is occupied FULL TIME by the owner or a long-term tenantThe stove is currently installed, operating, and in use.The stove/fireplace is the primary heat source (great than 50% of the heat).I understand the device may only be removed by the installer and will be recycled.I understand that a building permit will be required.I have included a photograph of the front of the existing woodstove or insert.I have included a photograph of the back of my woodstove (if accessible)

a. I understand that only a currently installed, operational, non-EPA certified wood burning device used as a primary source of heat is eligible to be replaced under this program.

b. I understand that participants are limited to receiving one voucher per address.

c. I understand that applications are processed in the order received. Vouchers will be distributed on a first-come, first-served basis. Funding is limited – there is no guarantee of a voucher. Vouchers are valid for four (4) weeks from issue date. Retroactive vouchers are NOT available. The expiration date may be extended at the discretion of the District.

d. I understand that applications will only be accepted for devices in Calaveras County.

e. I understand that if I qualify, I will receive a voucher and a current list of participating retailers who will honor the voucher if it is submitted by the voucher’s expiration date.

f. The participating retailer that installs the new device is responsible for removing, dismantling, and disposing of the old device.

g. If I use program funds, I commit to purchase a new device from a participating retailer within four (4) weeks and authorize the retailer to 1) notify the District of the purchase agreement, and 2) verify that my existing wood burning device is not EPA-certified.

h. I understand that devices purchased with funds from this program will be professionally installed by a licensed installer and that there may be additional costs for installation including permitting. Installations must comply with all local fire and building codes. The installation must be coordinated and certified by the participating retailer and must be completed within ninety (90) days of redeeming the voucher. Installation expiration date may be extended at the discretion of the District.

i. I understand that I am responsible to pay the retailer for the purchase of the new device, less the voucher amount.

j. I understand that I will forfeit my voucher if I provide the District with false information or fail to obtain any required permit or if the required information is not submitted to the District prior to the expiration date listed on the voucher.

k. The District does not warranty any devices purchased under this voucher program, including, but not limited to, the quality or functionality of the device.

l. I understand that proper wood burning practices (e.g., burning only dry, seasoned wood) and proper stove installation and operation (e.g., maintaining a hot fire) are critical to the effectiveness of my new device. I further agree to receive training on proper wood storage and wood burning practices (if applicable) and device operation and maintenance from the participating retailer or installer.

m. I understand that the District, CAPCOA, and the State of California may inspect all work and associated records with 30 days advanced notice.

n. Applications will be treated in accordance with Public Records Act requirements. Certain information, subject to those requirements, may be publicly disclosed.

Signature *

Date *