Humphrey Fire District Open Burning Permit Application

Humphrey Rural Fire District

Application for Temporary Open Burning Permit. This submission is ONLY valid once you receive an APPROVED email authorization following the email you will receive from this submission. The permit will be issued in accordance with Nebraska Statute 81-520.01. Other permits may be required from the Department of Environmental Quality - Phone (402) 471-3387 or the Department of Health and Human Services - Phone (402) 471-0386.
81-520-02. Open Burning Ban: range-management burning; violations; penalty.

Any person violating the statewide open burning ban established by section 81-520.01 or violating sections 81.520.03 to 81.520.05 shall be guilty of a Class IV misdemeanor. Source: Laws 1980, LB810 §3; 1989, LB19 §1; 1994, LB408 §2.
Date of Application*

MonthDayYear
Today's Date
Hour MinutesAM/PM Option
Applicant Name*

First NameLast Name
Email Address*
example@example.com
Address of Burn Location*

Street Address

Street Address Line 2

CityState

Zip Code
Person Supervising and responsible of the burn*

First NameLast Name
Phone Number of Person Supervising Burn*
Please enter a valid phone number.
Date of Burn *

MonthDayYear
Date
Burn Start & End Time*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Description of Material to be Burned:*
Allowable materials are natural vegetation, or untreated wood combustible materials. Plastics, Rubber, Petroleum, Treated or Painted Wood, and Trash are products that are illegal to burn. Burn sight may be subject to inspection prior to approval!
You, the applicant; Has reviewed Nebraska Statute 81-520.01*

YES, I understand if I should violate sections 81-520.03 to 81-520.04 I shall be guilty of a Class IV misdemeanor
You, the applicant; Will have water and/or other methods of extinguishing agents available and nearby the burn.*

YES, I will have water and/or other methods of extinguishing available
You, the applicant; Will check weather forecasts prior to burning and not burn during unfavorable or windy conditions.*

YES, I will check the forecast prior to burning
I hereby affirm and agree that only wood or wood by-products will be used for burning. I acknowledge and confirm that no tires, plastics, petroleum-based products, or any other non-wood materials will be included or permitted in the burning process. This agreement is made in full understanding of the environmental and safety regulations involved!*

I confirm that I will abide by the above outlined conditions and can be held legally responsible if I misuse this Open Burning Permit issued by the Humphrey Fire Department.
Signature of Applicant*

Clear
Signature assuming responsibility
Typed Name of Signing Party*
Name of Signing Party
BURNING IS NOT PERMITTED WITHOUT AN APPROVAL EMAIL FROM HUMPHREY FIRE DEPARTMENT.

Permits are issued between 7:00AM and 5:00PM. Submissions may take up to an hour for approval! Burning prior to approval is illegal! Humphrey Fire Department has the right to revoke permits under any condition as seen necessary.
Should be Empty:

Humphrey Rural Fire District

81-520-02. Open Burning Ban: range-management burning; violations; penalty.

BURNING IS NOT PERMITTED WITHOUT AN APPROVAL EMAIL FROM HUMPHREY FIRE DEPARTMENT.