Burning Permit Application

2. Application Date*
   Application Date

3. Requested Burn Date(s)*
   Requested Burn Date(s) Start Date

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   Requested Burn Date(s) End Date

5. Applicant(s) Name*

7. Address*

9. City*

10. State*

11. Zip*

13. Applicant(s) Phone*

14. Applicant(s) Email*

16. Burn Address (if different than above):

18. Provisions
    1) Use of rubber tires or products, which create a smoke nuisance, are expressly prohibited in a burning operation; 2) Fires must be attended by a competent person at all times with means to control the fire, such as, heavy equipment or a hose line with a water supply; 3) Do not place any debris in the incinerator after 5:00 PM; 4) The fire must be extinguished before leaving the scene; 5) Upon receiving a complaint on smoke nuisance, the fire shall be extinguished if the Fire Official deems it necessary; 6) Only vegetation and untreated wood may be burned. Burning of any of the following materials is unauthorized: heavy oils, asphalt products, plastics, vinyl materials, insulation, paper, cardboard, natural or synthetic rubber, salvage or scrap materials, chemicals, garbage, treated or painted wood, or any trash.

    1) Use of rubber tires or products, which create a smoke nuisance, are expressly prohibited in a burning operation; 2) Fires must be attended by a competent person at all times with means to control the fire, such as, heavy equipment or a hose line with a water supply; 3) Do not place any debris in the incinerator after 5:00 PM; 4) The fire must be extinguished before leaving the scene; 5) Upon receiving a complaint on smoke nuisance, the fire shall be extinguished if the Fire Official deems it necessary; 6) Only vegetation and untreated wood may be burned. Burning of any of the following materials is unauthorized: heavy oils, asphalt products, plastics, vinyl materials, insulation, paper, cardboard, natural or synthetic rubber, salvage or scrap materials, chemicals, garbage, treated or painted wood, or any trash.

20. Agreement
    The undersigned and holder of this permit does hereby agree that all applicable provisions of the 2012 International Fire Code, and amendments adopted by the City of Daphne, Alabama have been complied with and accept all responsibility for injury to any person(s) and/or damage to any property. He/She further agrees that any violation(s) of the obove provisions shall be cause for immediate revocation of this permit.

    The undersigned and holder of this permit does hereby agree that all applicable provisions of the 2012 International Fire Code, and amendments adopted by the City of Daphne, Alabama have been complied with and accept all responsibility for injury to any person(s) and/or damage to any property. He/She further agrees that any violation(s) of the obove provisions shall be cause for immediate revocation of this permit.

22. Digital Signature*

23. Date*
    Date

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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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