Recreational Fire Request - Miami Valley Fire District

Starting Date:*

Ending Date:*

Starting Time*

: HH

MM

Ending Time*

: HH

MM

Name*

First Last

Address*

Street Address City ZIP Code

Email*

Enter Email Confirm Email

24 Hour Phone Number*

THE BURN SHALL BE FOR RECREATIONAL USE ONLY.

A RECREATIONAL FIRE IS DEFINED AS A FIRE FOR DOMESTIC OR NON-COMMERCIAL COOKING OF FOOD. ALL OTHER BURNING WILL BE CONSIDERED ILLEGAL BY THE REGIONAL AIR POLLUTION CONTROL AGENCY (RAPCA).

NO STRUCTURE MAY BE WITHIN 25 FEET OF BURN SITE AT ANY TIME. THIS INCLUDES HOUSES, BARNS, SHEDS, FENCES, OR THE PERMIT CANNOT BE ISSUED. IF YOU ANSWER YES TO THE BELOW QUESTION YOU CANNOT COMPLETE THE PERMIT PROCESS.

Are there other structure(s) within 25 feet of the burn site ?*

This notification is only valid for the day and time period indicated.*

Yes ( I Understand)
NO

A copy of this notification form should be kept at the fire site.*

Yes ( I Understand)
NO

The burn site should be contained in a pit dug in the ground, no larger than 3 ft x 2 ft.*

Yes ( I Understand)
NO

Do not burn during adverse wind conditions and/or dry seasons, RAPCA Ozone Action Days.*

Yes (I Understand)
NO

Only well seasoned wood shall be burned. (No leaves, paper, grass, or trash)*

Yes ( I understand)
NO

Fire extinguisher equipment shall be available for immediate use at the fire site. (i.e. a bucket of water or garden hose or suitable size and type of fire extinguisher)*

Yes ( I understand)
NO

The Fire Must Be Constantly Attended Until Extinguished*

Yes (I understand)
NO

The fire must not create a nuisance or be offensive to others (i.e. neighbors)*

Yes (I understand)
NO

I must call the Regional Dispatch Center at 937.225.4357 just prior to the fire and after the fire is extinguished every time I have a recreational fire.*

Yes ( I understand)
NO

THE ATTENDANT AND PROPERTY OWNER OF THE BURN MUST AGREE TO THE TERMS LISTED ABOVE.

Failure to comply with the provisions and conditions as set forth may be cause for legal action against property owner and or fines. If fire equipment is dispatched on an illegal burn and the owner is found in violation of the conditions of this request the response fee is $1500.00.

This notification is not a permit and does not imply the Miami Valley Fire District has inspected the proposed burn site nor assumes any responsibility or liability for any damages caused by the open/recreational burning.

The Miami Valley Fire District reserves the right to extinguish any fire that fails to meet the above conditions of the fire code or that which creates an unsafe, dangerous or nuisance condition. Burning may also be suspended upon unfavorable weather or environmental conditions.

I understand and agree to comply with the above Ohio Fire Codes and Standards, I further understand that If I fail to comply with the Standards Fire Crews may extinguish the fire at their discretion and I may be billed for the fire department response. Checking Yes Is The Same as a Physical Signature*

Yes ( I understand)
NO

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