Name of Person Conducting Burning *

First Name

Last Name

Phone Number of Person Conducting Burning *

(###)

###

####

Address Where Burning Will Be Conducted

(if no address 2, please list "N/A")

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I understand that my burn area must be at least 50 feet from my home, my neighbors home and property line, or any business in my area. *

I Agree

I understand that I cannot start my burn until the official start time at 8a.m. and I must have my burn completely out by the official end time at 5p.m. *

I Agree

I understand it is illegal to burn any prohibited materials stated in the official burn permit packet *

I Agree

I understand that this permit is only valid until December 31st, 2024 *

I Agree

I understand that I am required to have a physical or digital copy of the burn permit packet on site of any open burn *

I Agree

I certify that I have knowledge of the facts herein set forth, that the same are true, accurate and complete to the best of my knowledge and belief. I further state that I will assume responsibility for conducting open burning in accordance with the Arizona Administrative Code Title 18, Chapter 2 and any open burning permitted issued thereof. *

I Agree