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Burn Permit Application

2. Village of Lombard
   Open Burning Permit Application
   Burn time to be no longer than 3 hours. Termination to be no later than 11:30PM.
4. Date of Application
6. Date of Burn
10. Applicant Name
12. Applicant Address
14. Day Phone Number
16. Evening Phone Number
18. Fax Number
20. Email Address
24. Are you the property owner?

    1. Yes
    2. No
26. If "NO", applicant hereby confirms that the property owner is aware of this application; has given permission to applicant to file this application; and has executed this application either in person or by electronic signature.
28. Property Owner Name
30. Property Owner Address
32. Day Phone Number
34. Evening Phone Number
36. PERMISSION IS HEREBY GRANTED TO THE APPLICANT TO BURN ON THE PROPERTY AS STATED HEREIN THIS APPLICATION.
38. Property Owner's Signature/Name
42. Address & Location of Fire
44. Purpose of Open Fire
46. Size of Open Fire
48. Type of Material to be Burned
50. Type of On-Site Fire Extinguishing Equipment
52. Hours of Burn
56. For Office Use Only
58. EPA Approval/Permit Required

    1. Yes
    2. No
60. Fire Chief or Fire Marshal
62. Conditions

    For Fire Chief or Fire Marshal Only

64. Approval
66. Date
68. Copies to: Applicant, Fire Stations, DuComm, & Lombard Police Department
Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit

* indicates a required field