CLASS "S" BURN PERMIT: SPECIAL USE
Slash - Three Day Permit
This is only a SAMPLE form. This form needs to be signed by Fire Department personel.
PERMIT ISSUED TO:
NAME: ___________________________________ ADDRESS:____________________________________
PHONE: ___________________________________ LOCATION: ___________________________________
This permit is subject to the following requirements:
ITEMS THAT CAN BE BURNED: Tree limbs 4” in diameter or less.
ITEMS THAT CANNOT BE BURNED: Any type of plastic, rubber products, paint, paint cans, fiberglass products, carpeting, furniture, stumps, household garbage, and noncombustible or fire rated material.
If any of the above rules are violated, this permit will be revoked immediately, and you may be issued a citation for illegal burning.
I, the undersigned, do hereby assert that I am the applicant or authorized agent of the applicant for this permit. I have read, reviewed, and understand the conditions and requirements for this permit and agree to abide thereby. I authorize an inspection of my burn area.
Applicant Signature____________________________ Date: _________________
Received by: _________________________________Date: _________________ Fee: $50.00
Assigned to: _________________________________ Date: _________________
Approved by: ________________________________ Date: _________________ Paid Cash/Check #_______