Type of Burn: Recreational Burn

eBURNING PERMIT FOR BURGETTSTOWN BOROUGH

2017

Name: ________________________________________________________________________

Location of Burn: _______________________________________________________________

Type of Burn: ____ Recreational Burn

____ $20.00 Permit Burn

Phone Number: ________________

Cell Phone: ______________________

Date Permit was received by Burgettstown Borough: __________________

Date Permit was reviewed and approved by Burgettstown Fire Department: ___________

___ By checking the box, you agree that you have read the burning ordinance and agree to

Comply with the regulations set forth by the Burgettstown Borough Ordinance No.2017-02

Chief of Burgettstown Borough Fire Department Signature:

Approved___________________________

Denied_____________________________

President, of Burgettstown Borough Signature:

Approved___________________________

Denied_____________________________