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  • Burn Permit Request

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    Katie Alaimo
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    This burn permit request form from the City of Roseburg Fire Department requires the requestor to provide their name, address, phone number, email, location of the planned burn, date of application, and signature. The fire marshal section indicates they will note if approved, the approval date, and any special conditions for the permit.

    Original Description:

    Burn permits will be issued during the month of October for $68.

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    This burn permit request form from the City of Roseburg Fire Department requires the requestor to provide their name, address, phone number, email, location of the planned burn, date of application, and signature. The fire marshal section indicates they will note if approved, the approval date, and any special conditions for the permit.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    210 views1 page

    Burn Permit Request

    Uploaded by

    Katie Alaimo
    This burn permit request form from the City of Roseburg Fire Department requires the requestor to provide their name, address, phone number, email, location of the planned burn, date of application, and signature. The fire marshal section indicates they will note if approved, the approval date, and any special conditions for the permit.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    City of Roseburg Fire Department

    Burn Permit Request

    Note: The burn permit requestor must fill out the fields below with current and accurate information to the
    best of their knowledge. Incorrect or falsified information may result in a rejection of the permit or an
    investigative inquiry of the requestor.

    Requestors Name: _____________________________________________________


    Current Address:

    _____________________________________________________

    Day Time Phone:

    _____________________________________________________

    E-Mail (optional):

    _____________________________________________________

    Location of Burn:

    _____________________________________________________

    Application Date:

    _____________________________________________________

    Requestors Signature:

    _______________________________________________

    Fire Marshal Use Only


    Approved By:

    _____________________________________________________

    Approval Date:

    _____________________________________________________

    Special Conditions: _____________________________________________________


    ________________________________________________________________
    ________________________________________________________________
    ________________________________________________________________
    ________________________________________________________________
    ________________________________________________________________

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