Fill - Free fillable Southbury Residential Open Burning Application-Permit-Fillable PDF form

LOCALOPENBURNINGOFFICIALAPPLICATIONANDPERMIT

FOROPENBURNINGOFBRUSHONRESIDENTIALPROPERTY



PERMITNUMBER:

TOWNOFSOUTHBURY

APPLICANTINFORMATION

ApplicantName: ApplicantSignature:

Applicant’sAddress: HomePhone:

Applicant’sEmail:

CellPhone:

ApplicanttoCheckBoxforDeclaration:

IDECLARETHATIAMARESIDENTOFTHEADDRESSASENTEREDONTHISFORM,THATTHISPROPERTYHASACERTIFICATEOFOCCUPANCY,

ANDTHATIWILLABIDEBYTHECONDITIONSOFTHISPERMITASSETFORTHINTHISDOCUMENT.

PERMITCONDITIONS

 ThisisavalidpermitonlywhensignedbytheLocalOpenBurningOfficial.

 ThepermitDOESNOTrelievethepermitteeofanylegalliability,whichmaybeincurredasaresultofthefire.

 Failuretoadheretotheconditionsofthepermitmayresultinpenalties

and/orotherenforcementactions.



ThisPermitisNOT

ValidUnderthe

Following

Conditions

 Whennationalorstateambientairqualitystandardsmaybeexceeded.

 Whereahazardoushealthconditionmightbecreated.

 WhentheAirQualityIndex(AQI)ispredictedtobe 75orhigheranywhereintheStateasindicated

intheTableentitled

“PredictedDailyAQIMaximumsforMonth/Day/Year”asfoundatwww.ct.gov/deep/aqi

 WhentheForestFireDangerLevelishigh,veryhigh,orextreme,asfoundatwww.ct.gov/deep/forestfiredanger

 WhenthereisanadvisoryfromtheStateofConnecticut’sDepartmentofEnergyandEnvironmentalProtectionofanyair

pollutionepisode.



General

Conditions:



ApplicabletoAll

Permits

1. Openburningislimitedtotheburningofbrushonly,onresidentialpropertyuponwhichthepermitteeresides.OnlyBrush

(definedasshrubs,vegetationorprunings,thediameterofwhichisnotgreaterthanthreeinchesatthewidestpoint)maybe



burned.Burningonpropertynotzonedorclassified asresidentialisprohibited.

2. BurningmustceaseifsodirectedbyanymemberoftheTownFireMarshal'sOffice,anyOfficeroftheFireDepartment,any

designatedmunicipalofficialresponsibleforenforcingtheopenburninglawsandordinances,oranyOfficialoftheState 

DepartmentofEnergyandEnvironmentalProtection.

3. Duringtheburn,allreasonablemeasurestoassurecompletecombustionandreduceexcessivesmokearetobetaken.

4. Atnotimeduringtheburnshouldthefirebeleftunattended.

5. Atthecompletionoftheburnperiod,allembersandcoalsmustbeextinguishedandwetted,soastopreventsmolderingand

fugitiveashemissions.

6. Allreasonablesafetyprecautionsaretobetaken,includingtheclearingofgrassandtreesintheburnarea,wettingdownof

thesurroundingarea,andtheplacementoffireextinguishersandhose

lines.

7. Thispermitmustbeimmediatelyavailableonsiteduringtheburn.

8. Burningmayonlybeconductedbetweenthehoursof10:00A.M.and5:00P.M.onasunnyorpartlysunnydaywiththewind

speedbetweenfiveandfifteenmilesperhour.Theburnpilemustbecompletelyextinguishedby5:00P.M.andallembers

andcoalsmustbeextinguishedandwetted(seeCondition5above).

9. Burningmaynotcreateanuisancetonearbyproperties.

THISSECTIONTOBECOMPLETEDBYTHELOCALOPENBURNING OFFICIAL



SpecialConditions:



Applicableif

Checked

 BurningmaybeinitiatedonlyinthepresenceoftheOpenBurningOfficial.

 Afirecrewandappropriateapparatusmustbestationedattheburningsite.

 Burningmaynottakeplacewhenthewindisfromthe______direction.

 Burning

mustbeconductedon:________day(s)betweenthefollowingdates:

 From:______/______/______to______/______/______

 Finalverbalapprovalmustalsobeobtainedonthedayofandpriortotheburningbycalling203‐262‐0637.

 ListmunicipalOpenBurningOrdinanceRequirements:



 Violationofthetermsand

conditionsofthispermitmaycausetheforfeitureofyourabilitytoqualifyforapermitinthe

future.

 Otherconditions:



 ThisapplicationisDENIEDforthefollowingreason(s):

 ThispermitisGRANTED

LocalOpenBurningOfficial’sSignature: Town:

Southbury

Date:

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Southbury Residential Open Burning Application-Permit-Fillable

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