CITY OF CISCO

OUTDOOR BURNING PERMIT

Date:_____________________

Address or location of outdoor burn (Attach map if necessary) ________________________________________________________________________________________________________________________________________________

Type of material to be burned_______________________

Submitted by:_________________________ Phone No.:_______________

                                                                         Cell Phone________________

Property Owner:_______________________ Phone No.:____________

DL# or SS#____________________

I hereby certify that I have read and examined this application and know the same to be true and correct.  All provisions of laws and ordinances  governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law, ordinance, or regulation.

Applicant Signature:________________________________________

Burn Location inspected by:_____________________ Fire Inspector

__Application Approved                                      Date:__________________

This permit is valid for ten (10) days from approval date; applicant must follow guidelines as prescribed attached to this application.

Application approved by: ________________________Fire Inspector

__ Application disapproved      

 Reason for disapproval __________________________________________________________________________________________________________________________

$25.00 FEE MUST ACCOMPANY APPLICATION