Northeast Teller County Fire District

Burn Permit/Inspection Request Form

All information is required.

Inspection date

Burn Address:

Legal Descriptions (Use either township, range, section -OR- latitude & longitude)

Township (## South)

Range (## West)

Section (May include 1/4 sections)

Latitude(Deg mm.mm)

Longitude(Deg mm.mm)

Property Owner

Phone Number

E-mail Address

Mailing Address

Responsible Party

Description of Burn Site: (fence, row, ditch, open area, burn barrel, size, etc.)

Type of Material Being Burned: (Wood, slash, etc.)

Check box	Conditions
	Prior to starting fire, Teller County Sheriff's Office (719) 687-9652 and Northeast Teller County Fire (719) 687-1866 shall be notified.
	Firefighting tools such as buckets, shovels, garden hoses, fire extinguisher (size determined by Fire District) must be readily available in case of an emergency.
	Emergency vehicles MUST have access and be able to reach the burn location at all times.
	At no time shall the burn be left unattended. Burning shall be supervised by one or more responsible adults (depending on size of burn)
	Burning shall be restricted to items and location indicated. All operations are subject to inspection by Northeast Teller County Fire & local law enforcement agencies.
	No fires shall be started after dark.
	No person shall maintain or start a fire that consists of hazardous materials; items being burned are limited to combustible organic materials only. NO HOUSEHOLD TRASH.
	The Fire Chief or fire department personnel acting on his behalf, is authorized to require that any fire be immediately discontinued if such fire is determined to constitute a hazardous condition.
	By submitting this form the submitter agrees to meet the requirements set forth in this permit. This permit can be revoked if applicant fails to comply with the conditions stated above. Cost to extinguish and repair damage will be assessed to the applicant for failure to comply with these guidelines. This permit is valid for one year from the date it was issued