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2. Village of Lombard
   Prescribed Burn Permit Application

   Prescribed burning shall be allowed after obtaining approval from the Village of Lombard Fire Department. Prescribed burning also requires a permit from the Illinois Environmental Protection Agency (IEPA). Restrictions may apply.

   
   

4. Date of Application
   Date of Application
6. Anticipated Date of Burn
10. Applicant Name
12. Phone Number
13. Email Address
15. Address
17. City
18. State
19. Zip Code
23. Are you the property owner?

    1. Yes
    2. No
24. 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.
26. Property Owner Name
27. Property Owner Phone Number
29. Property Owner Address
31. City
32. State
33. Zip Code
35. PERMISSION IS HEREBY GRANTED TO THE APPLICANT TO BURN ON THE PROPERTY AS STATED HEREIN THIS APPLICATION.
37. Property Owner's Electronic Signature/Name
41. Address & Location of Fire
43. Purpose of Open Fire
45. Size of Open Fire
47. Type of Material to be Burned
49. Type of On-Site Fire Extinguishing Equipment
51. Hours of Burn

53. Additional Information Required

    Please attach the following documents: 

55. Site Map
56. IEPA Permit
60. For Office Use Only
63. Fire Chief or Fire Marshal
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