Under the provisions of the International Fire Code and Township Ordinance Sec 30-101, 102, permission is hereby granted to this applicant to burn BRUSH ONLY during the period specified below. PERMITS ARE NOT VALID FOR MORE THAN (3) CONSECUTIVE DAYS. The permit may be revoked at any time for any reason deemed by the Fire Chief or Fire Department Representative. NO BURNING OF LEAVES, GRASS CLIPPINGS, CONSTRUCTION MATERIAL, PALLETS, OR ANY OTHER UNAUTHORIZED MATERIAL.

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Burn Permit Form

Name*

Address of Applicant*

Phone Number*

Email Address*

Address of Property of Burn*

Date Applied For*

Burning Period

Start Date*

End Date*

What is to be burned?*

Description of Property*