Applicant Name *

First Name

Last Name

Property Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of Burn *

MM

DD

YYYY

*

I have read and understand the Open Burn Ordinance and the materials permitted to be burned.

*

I understand that I am required to be with the fire at all times until it is completely extinguished. I understand that this permit does not mean I am exempt in the event that Blumfield Township Fire Rescue has to extinguish the fire. I understand that "building materials" are not acceptable items to be burned.