2. Burn Permits can only be submitted Mondays-Thursdays
4. First Name of Property Owner/Applicant*
5. Last Name of Property Owner/Applicant*
7. Address of Property Owner*
9. Applicant's Address, if different than above
11. Nearest Cross streets or other significant points of interest*
13. Property Owner's Phone Number*
14. Email Address*
16. Applicant's Phone Number
18. Name & Address of contractor, agent, or person who will conduct burning, if not done by the owner personally
20. Material To Be Burned*

    1. Brush
    2. Leaves
    3. Other
22. List Materials To Be Burned If Other Than Above
24. Time of burning must be between sunrise and one hour before sunset. When open burning is being conducted on vacant farm land, additional time may be approved by the Fire Department.
26. Additional Fire Department Conditions: (To be completed by Fire Dept if necessary)
28. Rules:
    1. The property owner agrees that this Permit, and all applicable and related Lenox Township Ordinances, is binding upon the owner, their contractors, their agents, or any other person who conducts such burning at their request or on their behalf. 2. The owner agrees that this Permit is valid for 14 days from the date issued and may be cancelled at any time if weather conditions change or if any complaints are received or as directed by the Fire Department. 3. The owner/or contractor and/or agent and/or any person who conducts the burning on the behalf of or at the request of the owner agrees to be responsible for providing a competent adult during the burning and to have the proper equipment to extinguish and prevent the fire from getting beyond control. HOMES MUST HAVE A CERTIFICATE OF OCCUPANCY TO OBTAIN A BURNING PERMIT. 4. The owner and/or contractor and/or agent and/or any person who conducts the burning on the behalf of or at the request of the owner agrees to completely extinguish the fire at least one hour before sunset. When open burning on vacant farm land, additional time may be approved by the Fire Department. 5. The owner and/or contractor and/or agent and/or any person who conducts the burning on the behalf of or at the request of the owner agrees that the fire shall be no larger than TWO FEET SQUARE AND THREE FEET HIGH. 6. The owner and/or contractor and/or agent and/or any person who conducts the burning on behalf of or at the request of the owner agrees that the material to be burned shall be only dry, non-toxic wood, brush, tree sumps, branches, hedge clippings, leaves, and grass clippings and that there shall be no burning whatsoever of any demolition, construction or building materials. 7. The owner and/or contractor and/or agent and/or any person who is clearing out vacant farm land intending to burn trees and brush that have been cut down on the property of an active farm operation for purposes of clearing land on which farm operations will be undertaken, provided that such open burning shall also comply with the following additional requirements: (a) The open burning shall not be permitted within TWO HUNDRED AND FIFTY (250) FEET of any state or county roadway. (b) The means of controlling and/or extinguishing such a fire shall include the placement of a front-end loader or other form of heavy earth moving equipment at the location of the fire; and (c) Prior to commencing any such open burning, the property ownder shall contact the Lenox Township Fire Department on its general business line (586) 749-6677 to inform the Department of the time the open burning will occur, in order to avoid the unnecessary dispatch, use and diversion of emergency equipment and personnel to the site of the open burning. 8. The owner and/or contractor and/or agent and/or any person who conducts the burning on the behalf of or at the request of the owner agrees that no flammable liquids were burned or used to start the fire. 8. The owner and/or contractor and/or agent and/or person who conducts the burning on the behalf of or at the request of the owner agrees that no burning shall occur within 50 feet of any structure constructed of combustible materials, or within 50 feet of any property line.
30. Time of Burning Must be Between Sunrise and one hour before Sunset
    I, the undersigned, shall be fully responsible for containing such open burning, and I shall abide by all listed above, Lenox Township Ordinance: Part 49: Ordinance 3, and shall assume any and all civil and/or criminal liabilities which may result from a failure to do so. I further understand that any person who shall violate any of the above provisions shall, upon conviction thereof, be subject to a fine not to exceed ($500.00) and/or by imprisonment in the county jail not to exceed (90) days or both. I, the undersigned, shall also abide the Lenox Township Ordinance: Part 49: Ordinance 1, the Fire Department and Ambulance Cost Recovery Ordinance, and agree to indemnify the Township for all costs, as contained in the Ordinance, shall it be necessary for the Lenox Township Fire Department and/or the Richmond Lenox EMS Ambulance Authority to respond to the fire that is the subject of this permit. I, the undersigned, further agree to indemnify the Township for such costs even if said fire was ignited by a contractor, an agent, or any other person acting on my behalf or at my request.
32. Signature of person making the request*
34. Do you agree?*

    By clicking "I agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I Agree
36. This permit is not active until returned with a valid Township approval.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field