City of LaHarpe

LaHarpe, Kansas 66751

BURNING PERMIT APPLICATION

The undersigned,______, is hereby granted a special permit

Under the provisions of Section 7-204 of said City, for the burning of non-hazardous solid waste.

This permit shall be effective and in force from ______and expire (10) ten

Consecutive days later on ______.

All burning under this permit shall be properly supervised (visibly present) by the undersigned or a person directly responsible to the undersigned.

In addition, the undersigned affirms that all liability for damage caused by any burning herein permitted is assumed by the execution of this permit. The undersigned shall in no way and under no circumstances hold the City of LaHarpe responsible for any damages, intentional or unintentional, or claims which results from the burning permitted herein.

THE UNDERSIGNED ALSO AGREES TO THE FOLLOWING STIPULATIONS AND INSTRUCTIONS WHEN BURNING:

(a)  NO burning shall commence before sunrise and shall be completely extinguished by sunset.

(b) NO burning during adverse weather conditions. Example: winds over 10 mph, fog exists or visibility is hampered.

(c)  ALL burning must be attended at all times. Burning of grass or grass clippings, brush, and leaves must be in manageable piles.

(d)  Burning must not occur in any right of way, alleys or streets. The location of the fire must be clear of overhead lines and clear from any exposure threat to any structure. (Fires must be at least 15 feet away from any structure by city ordinance)

(e)  A connected source of water or other directly available means of extinguishing piles or fires shall be available at all times while burning.

(f)  All burning is to be completely extinguished before leaving the burn site unattended.

NO BURNING OF TIRES, SHINGLES OR LUMBER ALLOWED

Signature______Address______

Description of what will be burned ______

CITY OF LAHARPE by:______

Fire Chief, City Clerk, (or designee)

DATE:______