Controlled Burn Authorization Request Form
Use this form to request approval for conducting a controlled burn. Please complete all required fields accurately.
Full Name
*
First Name
Last Name
Organization or Affiliation
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Burn Location / Address or Parcel Description
*
Proposed Burn Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Expected Burn Duration (hours)
*
Acreage / Area to be Burned (acres or sq. ft.)
*
Purpose of the Controlled Burn
*
Materials / Fuel to be Burned
*
Current Site Conditions (including weather and vegetation status)
*
Fire-Safety / Containment Measures
*
Emergency Contact (Name and Phone Number)
*
Submit Authorization Request
Should be Empty: