Burning Permit Application

Date of Application

Date of Proposed Fire

Name of Applicant

I am the: I am the: Property Owner Power of Attorney/Executor Legal Representative

Legal Representative Description

Phone Number

Email Address

Mailing Address

Location of Proposed Burn (if different from applicant's address):

Description of Material to be Burnt (i.e. dry wood):

Please select the Burn Permit you are requesting and acknowledge the conditions of the burning Please select the Burn Permit you are requesting and acknowledge the conditions of the burningCampfire/ Beach Fire ( No permit required)Yard Waste FireCategory 2 Brush / Slash BurningCategory 3 Industrial & Resource Management Burning

No permit is required for Campfire/Beach fires. Please review fire conditions but do not submit an application. No permit is required for Campfire/Beach fires. Please review fire conditions but do not submit an application. There will be a water supply available at the fire At least one responsible person (aged 16 years or older) equipped with a fire fighting hand tools monitor the fire at all times There are no trees or other combustibles within 1.5 metres? There no buildings within 5 metres. The fire will not burn any gasoline, oil, kerosene, tar, asphalt, animal organic waste, rubber, tires, asphalt shingles, battery boxes, plastic material, polypropylene, polystyrene, electric wires, plastic pipe, adhesives, hydro carbons or any similar material, which may be toxic and which may or may not produce heavy black smoke or create a noxious odor.

By checking these boxes, I confirm that I understand and will carry out the Yard Waste conditions listed below By checking these boxes, I confirm that I understand and will carry out the Yard Waste conditions listed below There will be a water supply available at the fire At least one responsible person (aged 16 years or older) equipped with a fire fighting hand tools monitor the fire at all times There are no trees or other combustibles within 5 metres? There no buildings within 10 metres Burning will only take place on a venting day listed as “Good” according to the BC Ventilation-index website for Central Vancouver Island, or call 1 (888) 281-2992. Ventilation Index The fire will only burn within the times of 1 hour after sunrise-to 2 hours before sunset. The fire will not burn any gasoline, oil, kerosene, tar, asphalt, animal organic waste, rubber, tires, asphalt shingles, battery boxes, plastic material, polypropylene, polystyrene, electric wires, plastic pipe, adhesives, hydro carbons or any similar material, which may be toxic and which may or may not produce heavy black smoke or create a noxious odor.

By checking these boxes, I confirm that I understand and will carry out the Category 2 conditions listed below By checking these boxes, I confirm that I understand and will carry out the Category 2 conditions listed below There will be a water supply available at the fire At least one person equipped with a fire fighting hand tools monitor the fire at all times? There are no trees or other combustibles within 10 metres There are no buildings within 500 metres. If setbacks can not be attained, advance 24-hour notice of the burn must be provided to residences within 500 meters of the burn. The fire will not burn any gasoline, oil, kerosene, tar, asphalt, animal organic waste, rubber, tires, asphalt shingles, battery boxes, plastic material, polypropylene, polystyrene, electric wires, plastic pipe, adhesives, hydro carbons or any similar material, which may be toxic and which may or may not produce heavy black smoke or create a noxious odor. Burning will only take place on a venting day listed as “Good” according to the BC Ventilation-index website for Central Vancouver Island, or call 1 (888) 281-2992. Ventilation Index A fuel break must be established around the burn area The fires will only burn within the times of 1 hour after sunrise-to 2 hours before sunset.

By checking these boxes, I confirm that I understand and will carry out the Category 3 conditions listed below By checking these boxes, I confirm that I understand and will carry out the Category 3 conditions listed below If the burn is within one kilometer of forest or grassland, the BC Wildfire Act and BC Wildfire Regulation procedures must be followed There are no residential or business buildings within 500 metres or 1000 meters of schools, hospitals and community care facilities (please review the BC Open Burning Smoke Control Regulation for alternative procedures for reduce set backs) A fuel break must be established around the burn area The fire will not burn any gasoline, oil, kerosene, tar, asphalt, animal organic waste, rubber, tires, asphalt shingles, battery boxes, plastic material, polypropylene, polystyrene, electric wires, plastic pipe, adhesives, hydro carbons or any similar material, which may be toxic and which may or may not produce heavy black smoke or create a noxious odor. Burning will only take place on a venting day listed as “Good” with the second day listed as “Good” or “Fair” according to the BC Ventilation-Index website for Central Vancouver Island or call 1 (888) 281-2992. Ventilation Index If your burn is in progress and is negatively impacting people or causing a navigation hazard by reducing visibility at nearby airports or highways, no more vegetative debris can be ignited or added to the burn until the conditions have improved. You cannot burn on more than 6 days in a month, for a maximum of 12 days in a year, on a single property Union Bay Fire Rescue must be contacted prior to ignition (250) 335-2345

List the BC Wildfire 1-888-797-1717 Burn Registration # List the BC Wildfire 1-888-797-1717 Burn Registration # Please write your Registration # in the box below:

List the BC Wildfire 1-888-797-1717 Burn Registration# (list number)

A 24-hour monitoring plan including observing personnel and fire fighting equipment is required (list number and size of concurrently burning piles, fire fighting equipment, heavy equipment on site, patrol person’s name, monitoring schedule, and contact information) A 24-hour monitoring plan including observing personnel and fire fighting equipment is required (list number and size of concurrently burning piles, fire fighting equipment, heavy equipment on site, patrol person’s name, monitoring schedule, and contact information) Please write your plan in the box below:

list number and size of concurrently burning piles, fire fighting equipment, heavy equipment on site, patrol person’s name, monitoring schedule, and contact information

Comments

ACCEPTANCE: ACCEPTANCE: I hereby accept the above noted terms and conditions and agree to indemnify and save harmless Union Bay Fire Rescue and the Comox Valley Regional District from any and all claims and liability which I or any other person may have fire or injury arising from this permit. Failure to comply with the terms and conditions of this permit renders it null and void.

Applicant Signature (Full Name)

Date