26 B Salt Mine Road
Camp Verde, Arizona 86322
928-567-9401
Pursuant to the International Fire Code, A.R.S. 49-501, 13-1706, and [A.A.C. R18-2-602.D.3p] burning shall be done only where other methods of residue disposal are impractical or unsatisfactory.
Applicant Name: Phone #:
Mailing Address:
City, State, Zip:
Physical Location of Burn Address:
Description of Burn Location: Residential Agricultural Commercial
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Type of Material to be Burned: Brush Grass Crop
Weeds Cut Tree: Diameter Inches
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Material to be Burned Shall Be: Piled / Burn Barrel Collected in a Pit Field Burning
Placed in Approved Waste Burner *
*Approved waster burner means an incinerator constructed of fire resistant material with a cover or screen that is closed when in use, and has openings in the sides or top no greater than one inch in diameter.
Estimated Quantity of
Material to be Burned Per Day: Size of pit (may require inspection), or
Number and size of Piles (maximum 4’ x 4’), or
Number of Acres
Purpose(s) of Burning: Weed Abatement
Fire Control and Suppression Resources Available: Water
Fire Prevention
(maximum fuel height 6”)
Crop Removal
Shovel / Equipment Fire Extinguisher
What Types of Actions Will Be
Taken to Minimize Emissions?
Minimize the Material to be Burned
Burn in Piles
Allow the Materials to Dry before Burning
Extinguish the Smoldering Burns
Use a Back Fire When Grass is Burned (burning in opposite direction of the wind)
THE PERMITTEE, TO THE FULLEST EXTENT OF THE LAW, AGREES TO INDEMNIFY, SAVE AND HOLD HARMELSS THE CAMP VERDE
FIRE DISTRICT, ANY AND ALL AGENTS, EMPLOYEES AND OFFICIALS OF THE CAMP VERDE FIRE DISTRICT FROM AND AGAINST ANY
AND ALL CLAIMS, SUITS, INCLUDING ATTORNEY’S FEES AND COST OF LITIGATION, ACTIONS, LOSS, DAMAGE, EXPENSE, COST OF
CLAIMS ARISING OUT OF FAILURE OF PERMITTEE OR THOSE ACTING UNDER THE PERMIT TO CONFORN TO ANY STATUTE,
ORDINANCE, REGULATION, LAW OR COURT DECREE. IT IS THE INTENT OF THE PARTIES TO THIS PERMIT THAT THE CAMP VERDE
FIRE DISTRICT, AND ALL AGENTS, EMPLOYEES AND OFFICIALS OF CAMP VERDE FIRE DISTRICT SHALL, IN ALL INSTANCES, BE
INDEMNIFIED AGAINST ALL LIABILITY, LOSSES AND DAMAGES OF ANY NATURE WHATEVER FOR OR ON ACCOUNT OF ANY INJURIES
TO OR DEATH OF PERSONS OR DAMAGES TO OR DESTRUCTION OF PROPERTY BELONGING TO ANY PERSONS ARISING OUT OF OR
IN ANY WAY CONNECTED WITH THE PERFORMANE OF THIS BURN PERMIT.
I HAVE READ AND UNDERSTAND ALL THE CONDITIONS FOR BURNING STATED ON THE BACK OF THIS FORM AND
AGREE TO ALL THE STATED CONDITIONS. I UNDERSTAND ANY DEVIATION WILL CONSTITUTE A VIOLATION
RESULTING IN A CITATION AND/OR POSSIBLE CANCELLATION OF THIS PERMIT.
Applicant Signature: ____________________________________________________________ Date: _______________________________

st
st
st
th
.
CVFD Representative Signature: ______________________________________________ Date: ________________________________
1.
Permittee shall call the Sedona Dispatch Center at (928) 282-7101, prior to burning to verify that no conditions exist under which burning is prohibited.
2.
Burn permits shall only be valid for the current calendar year and only during the designated burning dates.
3.
Burning is permitted between the hours of 7:00 a.m. and 4:00 p.m.
4.
A responsible adult (18 years of age or older) must be in attendance at all times until the fire is completely extinguished.
5.
Water under pressure and/or other means of extinguishment must be present and ready to use at all times during the burn and for a period not less than one (1) hour after the extinguishment of the burn.
6.
Material to be burned shall be dry, readily combustible, and placed in an approved arrangement.
7.
The location for open burning shall not be less than fifty (50) feet from any structure , and provisions shall be made to prevent the fire from spreading to within fifty (50) feet of any structure. (See drawing A below)
8.
Tar paper, oil, tires, ignition devices that cause the production of black smoke, or liquefied petroleum products such as gasoline or diesel may not be used to start or sustain ignition of the fire.
9.
Open burning is not permitted during wind advisories, high air pollution advisories, or periods of burn restrictions.
10.
Open burning shall not cause visibility impairment on traveled roads, create a public nuisance, or cause uncontrollable spread of the fire.
11.
A copy of the burn permit must be kept on-site during open burning. The permit shall not be construed to relieve the applicant from liability from resulting damages or the obligation to comply with other applicable laws, regulations, or ordinances.
12.
You may be required by the Camp Verde Fire District to extinguish or abstain from open burning during periods of inadequate smoke dispersion, excessive visibility impairment or at other times when public health or safety could be adversely affected.
13.
Open burning only allows the burning of untreated vegetative materials , and does not include burning household waste or prohibited material. Burning shall not present a health hazard, generate noxious or toxic fumes, or present a public nuisance.
14.
Prohibited materials shall not be burned . Prohibited materials includes nonpaper garbage from the processing, storage, service, or consumption of food; chemically treated wood; lead-painted wood; linoleum flooring, and composite counter-tops; tires; explosives or ammunition; oleanders; asphalt shingles; tar paper; plastic and rubber products, including bottles for household chemicals; plastic grocery and retail bags; waste petroleum products, such as waste crankcase oil, transmission oil, and oil filters; transformer oils; asbestos; batteries; anti-freeze; aerosol spray cans; electrical wire insulation; thermal insulation; polyester products; hazardous waste products such as paints, pesticides, cleaners, solvents, stains and varnishes, and other flammable liquids; plastic pesticide bags and containers; and hazardous material containers including those that contained lead, cadmium, mercury, or arsenic compounds.
15.
You may be responsible for any damage caused by a fire started by your open burning. You may be subject to civil penalties from damages caused by fires started by your open burning.
16.
Burning may be extinguished by fire personnel if the open burning is found to not be in compliance with all stated conditions.
17.
A fine of fifty dollars ($50) may be issued to the permittee if the open burning is found to not be in compliance with all stated conditions.
Camp Verde Fire District may revoke or suspend this permit for environmental conditions, failure to allow inspection, failure to make proper notification, or any conditions that would create a hazard to life or property.