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2. 
4. First Name*
5. Last Name*
7. Address*
8. Email Address*
10. City*
11. Zip Code
13. Phone Number*
15. General Information/ Disclaimer
    By signing this permit, applicants agree to abide by the following provisions of Ordinance 301: 1. No fire site may exceed dimensions measuring three feet in width, three feet in length, and two feet in height. 2. Only the burning of clean fire wood/logs is permitted. 3. Burning of refuse and other waste materials is strictly prohibited. 4. The recreational fire must be attended at all times and extinguished adequately after the activity. 5. The Township of Pine reserves the right to refuse a recreational fire due to dangerous circumstances. (i.e. drought, high winds, etc.) 6. A signed copy of this permit must be kept on location in case police or fire officials request it. 7. The location of the recreational fire shall not be within 15 feet of a structure unless the recreational fire is contained within an exterior fireplace structure or a fire containment feature for such use. 8. A means to extinguish the fire shall be on site at all times. Acceptable extinguishing equipment includes portable fire extinguisher, dirt or sand, water barrel or garden hose.
17. Single Fire*

    Is this permit for a one-time event?

    1. Yes

    1. No
18. If Yes,
    If Yes,
    Please indicate the date(s) of the event
20. Multiple Fires*

    Is this permit for multiple fires over a period of time?

    1. Yes

    1. No
21. If Yes,
    Permits will be valid for 6 months after the date of issuance.
23. More Information
    ACHD Open Burn Regulations and Facts

    Allegheny County Health Department Regulations
25. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
27. Electronic Signature Applicant*
28. Date *
    Date
30. The Wexford Volunteer Fire Company is seeking new volunteers for more information click the link.
    Wexford Volunteer Fire Company
32. Official Use Only

    Permit is:

    1. Issued
    2. Denied
33. Date Issued
    Date Issued
34. Date Expired
    Date Expired
36. Electronic Signature Fire Marshal*
Leave This Blank:


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

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field