Burn Ban Extension Request Form
Please fill out the form to request an extension for the burn ban.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Property Address
*
Reason for Extension Request
*
Please Select
Weather Conditions
Environmental Impact
Other
Proposed New End Date for Burn Ban
*
-
Month
-
Day
Year
Date
Description of Need for Extension
*
Acknowledge understanding of burn safety regulations
*
Option 1
Option 2
Option 3
Agree to follow all guidelines during extension period
*
Option 1
Option 2
Option 3
Signature
*
First Name
Last Name
Submit
Should be Empty: