Burn Permit
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Physical Location of the Burn
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County or Township or Range or Latitude / Longitude, Elevation
Description of Burning Location
Residential
Agricultural
Construction
Landfill
Fire Training
Range land
Other
If other, please explain
Type of Material to be Burned
Brush
Grass
Crop
Cut Tree
Other
(If Tree) Cut Tree diameter in inches
Other, Please explain
Quantity of Material to be Burned. (acres, pile, etc)
Material to be Burned Shall be:
Piled
Collected in a Pit
Placed in an Approved Waste Burner
Ignited in Place (field burning)
Ditch burning
Anticipated Duration per Burn in Hours
How long will it take to burn all material? (number of days)
Purpose(s) of burning:
Weed Abatement
Range Improvement
Fire Prevention
Crop Removal
Other
If other, please explain
What types of actions will be taken to minimize fire emissions including any Emission Reduction Techniques (ERT's)? ERT's include, but are not limited to:
Minimize the material to be burned.
Prevent fire from spreading by lining the area where open burn is conducted and application of fire retardant foam, or water.
Allow the material to dry before burning.
Minimize soil content in slash piles by constructing piles under dry soil conditions or by using hand piling methods.
Burn in piles.
Use a back fire when grass is burned. (back firing is burning in opposite direction of the wind)
Extinguish the smoldering burns.
Burn before litter falls.
Burn prior to precipitation.
Other
If you checked other, please provide a description of the techniques you will be using to minimize the emissions from your open burning activities.
Distance to residences and businesses closest to burn? (in feet or miles)
Map of burn location:
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I certify that I have knowledge of the facts herein set forth, that the same are true, accurate and complete to the best of my knowledge and belief. I further state that I will assume responsibility for conducting open burning in accordance with the Arizona Administrative Code, Title 18, Chapter 2 and any open burning permit issued thereof. *(Please type your signature)
Date
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Month
-
Day
Year
Date
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