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Burn Permit
Timber Mesa Fire and Medical
2922 W. White Mountain Blvd
Lakeside, AZ 85929
OPEN BURNING PERMIT
 
Permit #
*Valid From Date
Valid To Date
*Issued ToEnter your full name
*Telephone
*Physical Address
Is Address posted and visible from the street?
  Yes    No 
Type of Material to be burned
Agricultural Material
Tree Trimmings
Pine Needles/Leaves
Other
Describe Other
Amount of Material to be burned: Estimate number of cubic yards. (3`X3`X 3`=1cubic yard)
Number of cubic yards
 
Burning Regulations to be followed: Each Burning Regulation Below must be CHECKED as having been READ.
*1
1) Prior to burning any material, the Permittee shall call the Timber Mesa Fire and Medical open burn voice mail at 367-FIRE (367-3473) by 10:00 AM. After the beep, leave name, permit number and physical address of burn location.
*2
2) Burning shall be allowed from 6:00 AM to 6:00 PM daily unless otherwise stated by 367-FIRE.
*3
3) The burning material is to be observed at all times by a responsible adult until the fire is completely extinguished (no flame or smoldering material remains).
*4
4) During the burning period there must be a water source under pressure capable of extinguishing the fire if the need arises, as well as tools or other equipment approved by the Fire Chief or his designee.
*5
5) No burning will be allowed when wind conditions are over 10 MPH, unless written authorization is obtained from the Fire Chief. Under no circumstances will fires be allowed during Red Flag Conditions as set forth by the National Weather Service or US Forest Service or other restrictions in place.
*6
6) All materials to be burned must be cut and stacked in piles no larger than 3’ x 3’. Flame heights shall not exceed 4 feet.
*7
7) No burning shall be conducted within 20 feet of any structure, unless approved by the Fire Chief or his designee.
*8
8) BURNING OF THE FOLLOWING MATERIALS IS FORBIDDEN: Garbage, paper, cardboard, petroleum products (tarpaper, plastics, rubber, oil), treated construction materials, inorganic pesticides, lead, cadmium, mercury, or arsenic compounds.
*9
9) Any fire shall not produce dense, offensive smoke that could cross roadways to the extent a safety hazard occurs. Any fire that produces smoke that is offensive to neighbors shall be discontinued.
*10
10) Person(s) conducting open burning authorized by this permit shall have a copy of this permit on-site during permitted open burning operations, and shall produce a copy of this permit when requested to do so by fire /and or other authorized personnel.
*11
11) Recreational Fires are deemed as fires used for the purpose of cooking or warming. They shall be in an approved campsite or other type of approved device. Only wood, gas or charcoal may be used as a fuel source in these types of fires.
 
 
By my signature below, I acknowledge and will observe all applicable Arizona, Navajo County and Fire District laws and regulations. I also acknowledge that the Navajo County Board of Supervisors and the Fire District will not be held responsible for any property damage, personal injury, or inconvenience incurred, directly or indirectly, as a result of the issuance and execution of the intent. This issuance of this burn permit does not release the attendant from any of the requirements of any other jurisdictional agency or any applicable and legally constituted agreements. This burn permit issued in accordance with Arizona Department of Environmental Quality, Open Burning Guidelines for Air Pollution Control.
 
IMPORTANT INFORMATION PLEASE READ:

You must PRINT A COPY OF THIS COMPLETED FORM before or after Clicking on SUBMIT. You may be asked to see your copy by a Fire District member or Police Department staff.
 
PLEASE NOTE: Printing this Burn Permit before you CLICK Submit will print a (2) page document. Printing after you CLICK Submit will require a (4) page document.
 
 
Please Type your First Name in Box (1) and Last Name in Box (2)
By doing so you are agreeing to the Terms of this Burn Permit.
 
*Permitee First Name Signature Box (1)
*Permitee Last Name Signature Box (2)

 
The Fire District holds the right to revoke or cancel this intent to burn at anytime. This permit is issued by the authority of the Fire Chief and must be present at the burn site and presented to a Fire Officer or Law Enforcement Office upon request.
 
 
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