Application For Open Burning Permit

Applicant's Information

Applicant's Name*

First Last

Complete Mailing Address*

Street Address Address Line 2 City State ZIP Code

Email*

Applicant's Phone*

Site Information

Contractor's Phone

Street Address of Burn Site*

Street Address Address Line 2 City State ZIP Code

Location of Burn Site on Property

Purpose of Burn:*

Tree or Garden Trimmings
Land clearing/property maintenance
Bon Fire

Land-Disturbance Permit Number*

Date for Bon Fire

Description of Material to be Burned

Is material currently piled up?

Yes
No

(Pile must be ready for the site visit to be done)

Is the location less than 300 feet from any occupied dwelling for tree or garden trimmings, or 500 feet for land clearing and property maintenance?

Yes
No

Neighbor Permission Form

Has the neighbor permission slip been filled out by all effected?

Yes
No

Description of Material

(Max size: Bon Fire 5'x5'x5', Tree Trimmings 5'x5'x5', Land Clearing 25'x25'x15')

Height

Width

Is any burn material being brought from another site?

Yes
No

On-Site Means of Extinguishment:

Garden hose and hand tools
Heavy equipment
Fire extinguisher
Other

Please describe your means of Extinguishment:*

Terms of Agreement*

I agree

By clicking “I agree” I have read and agree to conduct this burn in accordance with the regulations described in the Henrico Fire, “Guidelines for Open Burning” and the Statewide Fire Prevention Code. Further, I understand that failure to follow the regulations will result in the suspension of the permit, issuance of a summons or both. ** Please allow 10 business days for processing of this application **

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Applicant's Information

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Description of Material

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