Residential Burn Permit RequestResidential Burn Permit 2021 Date * Name * Phone * Email * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/PostalAddress of Burn * Address of Burn Address of Burn Address of Burn City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Issue Date * Start Date of the Burn Expiration Date Please Read This permit allows the undersigned to have an open burn at the above specified location. The Pueblo Rural Fire Protection District ("PRFPD") takes no liability, responsibility or obligation and states that the undersigned has informed PRFD of the undersigned's intent to have this burn and to conduct it in a responsible way as not to lose control or inhibit any neighbor or other property. The undersigned is the owner or lessee of the above referenced property, at least 18 years of age and has read and agrees to the rules of burning associated with the Residential Burn Permit THIS BURN PERMIT EXPIRES ON 12/31/2021 Signature Clear Electronic Signature Acknowledgement * I the understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document Submit
