Waste Burner/Incinerator Permit Application

2. Application Date*
   Application Date

4. Applicant(s) Name*

6. Company Name

8. Applicant Address*

10. City*

11. State*

12. Zip*

14. Applicant(s) Phone*

15. Applicant(s) Email*

17. For the use of a Waste Burner/Incinerator to be located at (address):*

19. Permit Fee

    $75 Permit Fee per permit issued. Cash or check made payable to "City of Daphne" only.

    $75 Permit Fee per permit issued. Cash or check made payable to "City of Daphne" only.

21. 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.

    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.

23. Agreement

    The applicant of this permit will hereby agree to all of the provisions and accept all responsibility for injury to any person(s) and/or damage to any property. The holder further agrees that any violation(s) of the provisions shall be cause for immediate revocation of said permit. The undersigned of this permit application 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 above provisions shall be cause for immediate revocation of this permit.

    The applicant of this permit will hereby agree to all of the provisions and accept all responsibility for injury to any person(s) and/or damage to any property. The holder further agrees that any violation(s) of the provisions shall be cause for immediate revocation of said permit. The undersigned of this permit application 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 above provisions shall be cause for immediate revocation of this permit.

25. Digital Signature*

26. Date*
    Date

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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field