Fire Permit Application Form

Regional Fire Services

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Fire Permit Application Form

<form-template>
	<fields>
		<field type="header" subtype="h3" label="Please choose a burn type:" class="header"></field>
		<field type="select" required="true" label="Which burn type are you applying for? " description="Select which burn type you are applying for." placeholder="Select" class="form-control select" name="select-1641924274434">
			<option value="--Select from List--">--Select from List--</option>
			<option value="Yard Clean Up / Burn Pit">Yard Clean Up / Burn Pit</option>
			<option value="Field Stubble / Balefire">Field Stubble / Balefire (additional requirements)</option>
		</field>
		<field type="header" subtype="h3" label="Please read carefully:" class="header"></field>
		<field type="paragraph" subtype="p" label="For field stubble and balefire applicants ONLY!" class="paragraph"></field>
		<field type="paragraph" subtype="blockquote" label="A fireguard and an adequate water source is required. Please indicate below that you have both disked around the intended burn area and that you have an adequate water source available at all times. Not required for Yard Clean Up and Burn Pit applications." class="paragraph"></field>
		<field type="paragraph" subtype="p" label="As a field stubble or balefire applicant, I can verify that:" class="paragraph"></field>
		<field type="checkbox" label="I have disked around the burn area, and;" description="Field stubble and balefire applicants only" class="checkbox" name="checkbox-1569881676760" value="I have disked around the burn area"></field>
		<field type="checkbox" label="I have an adequate water source available." description="Field stubble and balefire applicants only" class="checkbox" name="checkbox-1569881726056" value="I have an adequate water source available"></field>
		<field type="paragraph" subtype="p" label="_____________________________________________________________________________________________________________________________________" class="paragraph"></field>
		<field type="header" subtype="h3" label="Applicant's information:" class="header"></field>
		<field type="text" subtype="text" label="Business Name" placeholder="Business Name" class="form-control text-input" name="text-1568411589658"></field>
		<field type="text" subtype="text" required="true" label="First Name" placeholder="First Name" class="form-control text-input" name="text-1568411590794"></field>
		<field type="text" subtype="text" required="true" label="Last Name" placeholder="Last Name" class="form-control text-input" name="text-1568411588570"></field>
		<field type="text" subtype="text" required="true" label="Phone Number" placeholder="Phone Number" class="form-control text-input" name="text-1568411587611"></field>
		<field type="text" subtype="email" required="true" label="Email Address" placeholder="Email Address" class="form-control text-input" name="text-1568411643127"></field>
		<field type="radio-group" required="true" label="Owner or Lessee" class="radio-group" name="radio-group-1626108797443">
			<option value="Owner" selected="true">Owner</option>
			<option value="Manager">Manager</option>
			<option value="Lessee">Lessee</option>
		</field>
		<field type="select" label="Quarter" class="form-control select" name="select-1568412519426">
			<option value="--Select from List--" selected="true">--Select from List--</option>
			<option value="NW">NW</option>
			<option value="NE">NE</option>
			<option value="SW">SW</option>
			<option value="SE">SE</option>
		</field>
		<field type="select" label="Section" class="form-control select" name="select-1587490824379">
			<option value="--Select from List--" selected="true">--Select from List--</option>
			<option value="1">1</option>
			<option value="2">2</option>
			<option value="3">3</option>
			<option value="4">4</option>
			<option value="5">5</option>
			<option value="6">6</option>
			<option value="7">7</option>
			<option value="8">8</option>
			<option value="9">9</option>
			<option value="10">10</option>
			<option value="11">11</option>
			<option value="12">12</option>
			<option value="13">13</option>
			<option value="14">14</option>
			<option value="15">15</option>
			<option value="16">16</option>
			<option value="17">17</option>
			<option value="18">18</option>
			<option value="19">19</option>
			<option value="20">20</option>
			<option value="21">21</option>
			<option value="22">22</option>
			<option value="23">23</option>
			<option value="24">24</option>
			<option value="25">25</option>
			<option value="26">26</option>
			<option value="27">27</option>
			<option value="28">28</option>
			<option value="29">29</option>
			<option value="30">30</option>
			<option value="31">31</option>
			<option value="32">32</option>
			<option value="33">33</option>
			<option value="34">34</option>
			<option value="35">35</option>
			<option value="36">36</option>
		</field>
		<field type="select" label="Township" class="form-control select" name="select-1587490990252">
			<option value="--Select from List--" selected="true">--Select from List--</option>
			<option value="7">7</option>
			<option value="8">8</option>
			<option value="9">9</option>
			<option value="10">10</option>
			<option value="11">11</option>
			<option value="12">12</option>
			<option value="13">13</option>
			<option value="14">14</option>
			<option value="15">15</option>
		</field>
		<field type="select" label="Range" class="form-control select" name="select-1587491052869">
			<option value="--Select from List--" selected="true">--Select from List--</option>
			<option value="12 W4">12 W4</option>
			<option value="13 W4">13 W4</option>
			<option value="14 W4">14 W4</option>
			<option value="15 W4">15 W4</option>
			<option value="16 W4">16 W4</option>
			<option value="17 W4">17 W4</option>
			<option value="18 W4">18 W4</option>
			<option value="19 W4">19 W4</option>
			<option value="20 W4">20 W4</option>
		</field>
		<field type="text" subtype="text" label="Hays Block" placeholder="Hays Block" class="form-control text-input" name="text-1568412624615"></field>
		<field type="textarea" required="true" label="Purpose for Burning" class="form-control text-area" name="textarea-1568411744720"></field>
	</fields>
</form-template>