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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.

   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. Conditions

62. Approval

64. Date

68. Fire Chief or Fire Marshal

70. Conditions

72. Approval

74. Date

76. Copies to: Applicant, Fire Stations, DuComm, & Lombard Police Department

Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit

* indicates a required field