Fillable Burn Permit Application VILLAGE OF LINCOLNSHIRE

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Burn Permit Application VILLAGE OF LINCOLNSHIRE

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The Burn Permit Application VILLAGE OF LINCOLNSHIRE form is 6 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Village of Lincolnshire

BROWSE VILLAGE OF LINCOLNSHIRE (IL) FORMS

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CONTROLLED/PRESCRIBED VEGETATION BURN
APPLICANT INFORMATION
Address of Burn:
Project Name:
Date:
Applicant/Agent Name:
Phone Number:
Applicant/Agent Email:
Fax:
Property Owner Name:
Phone:
Property Owner Email:
Fax:
IEPA Open Burning Permit#:
Type of Burn:
TO BE COMPLETED BY APPLICANT: BURN LEADER INFORMATION
COMMERCIAL TREE REMOVAL REQUESTS MUST INCLUDE A SITE LANDSCAPE PLAN
IDENTIFYING THE LOCATION OF TREE(S) TO BE REMOVED AND REPLACEMENT TREE(S)
Name:
Direct Phone Number During Burn:
Certification/Qualifications:
Certification and/or License Attached:
No
TO BE COMPLETED BY VILLAGE
Public Works:
Permit Number:
Residential Site Inspection Date:
Deposit Code: 114
Attachments
1. IEPA Open Burning Permit and Supporting Materials
2. Detailed Site Plant
3. Hold Harmless and Indemnity Undertaking
4. Qualifications and/or Certification of Burn Leader
5. Property Owner Notification Form (Residential)
6. Proof of Insurance
7. Permit Fees
Commercial Permit Fee: $100
Residential Permit Fee: $50
Submit the completed application the address/fax below.
Conditions of Permit and Materials to be submitted with the permit application:
1. Submit a valid and current Open Burning Permit from the Environmental Protection Agency
and supporting documentation.
2. No burning shall take place within the following:
a. No burn shall take place closer than fifty (50) feet from any structure
Controlled/Prescribed Vegetation Burn – Village of Lincolnshire, IL – Public Works
Development
Page 2 of 6
b. Residential: woodland burns on residential property shall have a minimum buffer of five (5)
feet. Prairie or rain garden buffers shall be a minimum of ten (10) feet.
3. Submit a detailed site plan, specifying (use a site survey or other property plan):
a. The exact area of the burn,
b. All adjacent property boundaries,
c. All structures and use within fifty (50) feet of the boundaries of the burn area,
d. The location of the natural and planned fire breaks.
4. Submit a signed Hold Harmless and Indemnity Undertaking
5. Submit the name and qualifications of the burn leader.
a. A certification as such by State agency and/or
b. Verification that this individual is a full-time firefighter with an Illinois municipality or Fire
Protection District with classroom and field training in open burning management and/or
c. Proof of certified training in natural area management that has included actual classroom
and field training in controlled burning of ground vegetation.
6. If the burn is to take place on residential property, a site inspection by the Village is required prior
to a permit application.
7. Notification
a. Residential: all property owners who adjoin the property to be burned shall be notified of
the burn. The property Owner Notification shall be submitted with the permit application.
b. School District 103: Margaret Van Duch, communications coordinator of District 103
mvanduch@d103.org , shall be notified 3 hours prior to the start of the burn.
c. Commercial and Residential:
i. A notification shall be sent to all property owners within two hundred fifty feet (250’)
of the boundaries of the burn area. The notification must indicate a time frame and
duration of when the burning will take place. For example: “Controlled burning shall
take place between April 15
th
and 22
nd
between the hours of 9:00 a.m. and 3:00
p.m. It is estimated the burning will be completed within one day”
ii. Proof of written notification to the Village and the local Fire Protection District of the
time frame and when the burning will take place as detailed above.
iii. At least one (1) hour prior to the star of the burning, the burn leader shall obtain
permission to burn from:
1. Village of Lincolnshire Public Works – 847-883-8600
2. Lincolnshire Police Department – 847-883-9900
3. Fire Protection District – 847-634-2512
The burn leader shall provide:
1. Village permit number,
2. Location and anticipated completion time.
No burning shall be allowed unless all of these departments provide permission for
the burn at the time of contact.
iv. Proper notification signage shall be provided by the applicant prior to the burn
beginning. Signs that communicate that a Controlled Burn is currently In-Progress
are required to be posted in the immediate area of the controlled burn to minimize
false-alarm reports of a fire or confusing an actual fire in the area with a controlled
burn.
v. Thirty minutes prior to the start of the burning the burn leader shall contact by
phone Red Center (Regional Emergency Dispatch Center) – 847-724-5700
8. At the conclusion of the burning, the burn leader shall contact the Village of Lincolnshire Public
Works, the Lincolnshire Police Department, the Fire Protection District and Red Center to advise
Controlled/Prescribed Vegetation Burn – Village of Lincolnshire, IL – Public Works
Development
Page 3 of 6
that the burning has been completed and all fire and smoldering have been completely
extinguished.
9. The permit applicant shall provide to the Village a certificate of insurance as evidence of insurance
coverage for general liability with coverage limits of not less than $2,000,000 directly related to
controlled burning activity.
10. Within forty-eight (48) hours of the burn, the applicant must submit a Post Burn Report with the
Village of Lincolnshire Public Works Department, stating:
a. Whether the purpose of the burn was accomplished,
b. The percentage of the area burned,
c. Whether any damage was done outside of the specified area, and
d. A site diagram identifying the area burned.
11. Submit a permit fee and the completed application to the Village.
a. Commercial permit fee: $100
b. Residential permit fee: $50
Controlled/Prescribed Vegetation Burn – Village of Lincolnshire, IL – Public Works
Development
Page 4 of 6
HOLD HARMLESS AND INDEMNITY UNDERTAKING
FOR PRESCRIBED/CONTROLLED BURNING
The applicant on his or her own behalf and on behalf of applicant’s agents and employees, hereby
agrees to hold the Village and the Lincolnshire Riverwoods Fire Protection District and their respective
officers, agents and employees of each, harmless and indemnified against any and all losses, damages
or claims of whatever kind or nature that may be suffered or purportedly suffered by the applicant or
any third party, for any act or failure to act in any way arising out of the controlled burning on the
premises or the Village’s permitting of the controlled burning, including any halting of the burn, whether
justified or not, by the Village or the District. This shall include, but not be limited to, any settlement,
payment or judgment and any and all costs, including attorney’s fees suffered by either the District or
the Village because of the controlled burn or the Village and/or the District permitting or supervising of
the burn. The property owner and any person conducting a prescribed burn shall be liable for any actual
damage or injury caused by the fire or resulting smoke upon proof of negligence.
The applicant recognizes that any exposure to any liability of either the Village or the District arises
solely because of the desire of the applicant to conduct this controlled burn. Therefore, it is the
intention of the applicant that the applicant, by this undertaking, will assume the complete
responsibility for any loss or cost to anyone, for any reason, and neither the Village nor the District
assumes any liability or shall incur any expense with respect to this controlled burn. The granting of the
permission to conduct the controlled burn is sufficient consideration for this undertaking by the
applicant.
Company:
Signature:
Date:
Title:
PRESCRIBED/CONTOLLED BURN PROPERTY OWNER NOTIFICATION FORM
The property at address: _______________________________ is planning to conduct a
prescribed/controlled burn. A prescribed/controlled burn is a management tool used to maintain
naturalized areas. The burn will assist in the reduction of invasive plant species and the health and
vitality of deep rooted native vegetation.
The burn will be conducted during the following period:
Fall:
Spring:
Year:
The property owner at the above address would like to burn the following areas:
Location:
Type of Vegetation:
Woodland:
Prairie:
I understand that my property shares a common border with the address listed above.
The property owner shall not burn any area which is closer than fifty (50) feet to any residential structure.
The property owner shall construct a fire buffer area of not less than five (5) feet for a woodland burn and
not less than ten (10) feet for a prairie burn.
The burn shall be conducted by a certified and/or licensed burn professional who has provided proof of
insurance.
The Lincolnshire Riverwoods Fire Protection District, the Lincolnshire Police Department and the Village of
Lincolnshire shall be notified prior to the start of the burn and at the conclusion of the burn.
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Controlled/Prescribed Vegetation Burn – Village of Lincolnshire, IL – Public Works
Development
Page 5 of 6
The property owner, at the address listed above has my permission to conduct a prescribed/controlled burn.
Name:
Address:
Signature:
Date:
I wish to be notified at least three hours prior to the start of the burn:
Name:
Address:
Signature:
Date:
I wish to be notified at least three hours prior to the start of the burn:
Name:
Address:
Signature:
Date:
I wish to be notified at least three hours prior to the start of the burn:
Name:
Address:
Signature:
Date:
I wish to be notified at least three hours prior to the start of the burn:
PRESCRIBED/CONTOLLED VEGETATION BURN FINAL REPORT FORM
Permit Number:
Date of Burn:
Address of Burn:
Person Completing the Final Report:
Phone Number:
Email Address:
REPORT:
Type of Burn:
Woodland:
Prairie:
Weather:
Temperature:
Humidity:
Wind:
Percentage Burned:
Reasons why burn location did not burn as desired (ex: Non-native vegetation, ground moisture, wind,
etc.)
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Controlled/Prescribed Vegetation Burn – Village of Lincolnshire, IL – Public Works
Development
Page 6 of 6
DIAGRAM OF BURN SITE: (Identify areas that were burned and areas that were not burned):
Comments, problems or other issues relevant to the burn:
Recommendations for next time:
Recommended frequency for future burns:
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Burn Permit Application VILLAGE OF LINCOLNSHIRE

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Completed 13 July 2020

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