LOCALOPENBURNINGOFFICIALAPPLICATIONANDPERMIT
FOROPENBURNINGOFBRUSHONRESIDENTIALPROPERTY
PERMITNUMBER:
TOWNOFSOUTHBURY
APPLICANTINFORMATION
ApplicantName: ApplicantSignature:
Applicant’sAddress: HomePhone:
Applicant’sEmail:
CellPhone:
ApplicanttoCheckBoxforDeclaration:
IDECLARETHATIAMARESIDENTOFTHEADDRESSASENTEREDONTHISFORM,THATTHISPROPERTYHASACERTIFICATEOFOCCUPANCY,
ANDTHATIWILLABIDEBYTHECONDITIONSOFTHISPERMITASSETFORTHINTHISDOCUMENT.
PERMITCONDITIONS
ThisisavalidpermitonlywhensignedbytheLocalOpenBurningOfficial.
ThepermitDOESNOTrelievethepermitteeofanylegalliability,whichmaybeincurredasaresultofthefire.
Failuretoadheretotheconditionsofthepermitmayresultinpenalties
and/orotherenforcementactions.
ThisPermitisNOT
ValidUnderthe
Following
Conditions
Whennationalorstateambientairqualitystandardsmaybeexceeded.
Whereahazardoushealthconditionmightbecreated.
WhentheAirQualityIndex(AQI)ispredictedtobe 75orhigheranywhereintheStateasindicated
intheTableentitled
“PredictedDailyAQIMaximumsforMonth/Day/Year”asfoundatwww.ct.gov/deep/aqi
WhentheForestFireDangerLevelishigh,veryhigh,orextreme,asfoundatwww.ct.gov/deep/forestfiredanger
WhenthereisanadvisoryfromtheStateofConnecticut’sDepartmentofEnergyandEnvironmentalProtectionofanyair
pollutionepisode.
General
Conditions:
ApplicabletoAll
Permits
1. Openburningislimitedtotheburningofbrushonly,onresidentialpropertyuponwhichthepermitteeresides.OnlyBrush
(definedasshrubs,vegetationorprunings,thediameterofwhichisnotgreaterthanthreeinchesatthewidestpoint)maybe
burned.Burningonpropertynotzonedorclassified asresidentialisprohibited.
2. BurningmustceaseifsodirectedbyanymemberoftheTownFireMarshal'sOffice,anyOfficeroftheFireDepartment,any
designatedmunicipalofficialresponsibleforenforcingtheopenburninglawsandordinances,oranyOfficialoftheState
DepartmentofEnergyandEnvironmentalProtection.
3. Duringtheburn,allreasonablemeasurestoassurecompletecombustionandreduceexcessivesmokearetobetaken.
4. Atnotimeduringtheburnshouldthefirebeleftunattended.
5. Atthecompletionoftheburnperiod,allembersandcoalsmustbeextinguishedandwetted,soastopreventsmolderingand
fugitiveashemissions.
6. Allreasonablesafetyprecautionsaretobetaken,includingtheclearingofgrassandtreesintheburnarea,wettingdownof
thesurroundingarea,andtheplacementoffireextinguishersandhose
lines.
7. Thispermitmustbeimmediatelyavailableonsiteduringtheburn.
8. Burningmayonlybeconductedbetweenthehoursof10:00A.M.and5:00P.M.onasunnyorpartlysunnydaywiththewind
speedbetweenfiveandfifteenmilesperhour.Theburnpilemustbecompletelyextinguishedby5:00P.M.andallembers
andcoalsmustbeextinguishedandwetted(seeCondition5above).
9. Burningmaynotcreateanuisancetonearbyproperties.
THISSECTIONTOBECOMPLETEDBYTHELOCALOPENBURNING OFFICIAL
SpecialConditions:
Applicableif
Checked
BurningmaybeinitiatedonlyinthepresenceoftheOpenBurningOfficial.
Afirecrewandappropriateapparatusmustbestationedattheburningsite.
Burningmaynottakeplacewhenthewindisfromthe______direction.
Burning
mustbeconductedon:________day(s)betweenthefollowingdates:
From:______/______/______to______/______/______
Finalverbalapprovalmustalsobeobtainedonthedayofandpriortotheburningbycalling2032620637.
ListmunicipalOpenBurningOrdinanceRequirements:
Violationofthetermsand
conditionsofthispermitmaycausetheforfeitureofyourabilitytoqualifyforapermitinthe
future.
Otherconditions:
ThisapplicationisDENIEDforthefollowingreason(s):
ThispermitisGRANTED
LocalOpenBurningOfficial’sSignature: Town:
Southbury
Date:
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