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2. First Name*
3. Last Name*
5. Address*
6. City*
7. Zip Code*
9. Phone Number*
11. Burn Site Address (if different than above): if no address give quarter section, section, township, range and name of nearest county road.
13. Outdoor Burning Ordiance- see prohibited materials on page 4 of the linked ordiance.
    Burning Ordinance- Please Read
14. I read the prohibited materials section of the Outdoor Burning Ordinance.*

    1. Yes
16. Electronic Signature
17. Today's Date:
    Today's Date:

    This permit expires on December 31 of the year of issuance.

19. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I Agree
21. Conditions / Restrictions:

    1. Burning conditions shall be obtained each day before starting to burn. The toll-free burning information line can be accessed at 1-800-633-0709 or call Wahkiakum County Communications at 360-795-3242 or on the internet at www.swcleanair. org. 2. Burning must be restricted to natural vegetation grown on the property where burning occurs. All other material is prohibited, except what paper is necessary to start the fire. (WAC 173-425-040) 3. No fires are to be within 50 feet of any structures. No open fires are to be within 25 feet of property lines or other combustible materials. 4. A person capable of extinguishing the fire shall attend it at all times and the fire must be totally extinguished before leaving it. 5. A garden hose connected to a water supply or other approved fire extinguishing equipment must be at the burning site and ready to use. (Uniform Fire Code) 6. Only one burn pile may be burned at a time, and the fire must be extinguished before starting another. The pile must not be larger that four feet by four feet by three feet. 7. Burning must be conducted during daylight hours only. The fire must be started no earlier than 1/2 hour after sunrise and be extinguished 1/2 hour before sunset. 8. No fire is permitted in or within five hundred (500) feet of forest slash without written large fire permit. 9. If the fire creates a nuisance, it shall be extinguished. (WAC 173-425-030(8)) 10. When burning on land belonging to others, permission from the owner, or owners designated representative shall be obtained before starting the fire. I have read and understand the provisions specified above and accept the responsibility to comply with all of the conditions. I understand this permit does not release me from liability for damages resulting from the spread of fire, and that violation of these conditions may result in enforcement action. Contact local permitting authority at 360-795-3067 if you are unable to comply, or permit does not meet the needs of your particular situation.

23. Would you like to receive an email reminder to fill out a new Small Burn Permit in January of 2024?*

    1. Yes, email me a burn permit application in January of 2024
    2. No
25. Email Address (If you want to receive a burn permit application by email in January of 2024)
27. THIS PERMIT SHALL BE KEPT AT THE FIRE SITE.
29. PRINTING INSTRUCTIONS
    TO PRINT, click on "Submit and Print", then when the next screen pops up, Right click, and click on the menu option "Print", then you can select your printing location on your computer.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field