Please complete the following information.

Previous Burn Permit #:

Date of Birth*

Name:*

Company:

Address:*

City:*

State: *

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Zip:*

Phone Number:*

Cellular Phone:

Email Address:*

Is the burning location within 1/2 mile of Manhattan City limits?*

Yes

No

Is the burning location within Ogden City limits?*

Yes

No

Do you burn over 20 acres for range or pasture management?*

Yes

No

Is this a commercial operation? (KDHE permit required .pdf or .doc)*

Yes

No

I understand that I have the sole responsibility for supervision and control of any fire I start and this permit does not relieve me or the people assisting me from burning in a safe manner. I understand that I may be held liable for damage to the property of another caused by the burning.

I agree to comply with Riley County resolution #092399-32, the Kansas Administration Regulations 28-19-647 and 28-19-648, and or any amendments to such. *

Yes

No

Signed (Enter your name):*

You will receive your new burn permit number after your application has been processed.

If you have any questions, please call 785-537-6333.