Somerset County Health Department
7920 Crisfield Hwy.
Westover, MD 21871
(443) 523-1730

APPLICATION FOR USE OF OPEN FIRES

Type or print information            Complete and Return

1.  Applicant:_____________________________  Phone: _______________

2.  Mailing Address:_______________________________________________

3.  Tax Map, Block & Parcel:_______________________________________

4.  Location of Property: _________________________________________
                             (911 Address, Street, Directions)
___________________________________________________________________
                            (Subdivision, Town)     
5.  Area of property:___________________________________________ acres

6.  Distance to :  Nearest occupied dwelling: _____________ feet
	           Public thoroughfare:____________________ feet

7.  Purpose (check one):  a.______ Demolition
                          b.______ Land Clearing (How many acres?_____)
			  c.______ Agricultural (specify)

8.  Provide plat or sketch of property on second page.

$60.00 FEE IS DUE AND PAYABLE AT TIME OF APPLICATION.
  THIS IS A NONREFUNDABLE FILING AND PROCESS FEE.

____________________________________     _________________
  Signature of Applicant/Agent		       Date

                                     
NOTE:  Exceptions to Regulations Governing the Control of Air Pollution
in the State of Maryland, (26.11.09), and area VI (43P07), provided no nuisance
is created.  Should the activity result in the creation of a nuisance, this
permit shall be void.

Site inspection by: ___________________  Approved by:__________________

                      
                on: ___________________           on:__________________

        
Open fires may not be employed when it is announced by a State or County official
that the interest of public comfort or safety such open burning not be conducted.

 _______________________________     Expires:_______________________
Health Officer

PROPERTY SKETCH (Indicate North)

                                               Scale____________    Inch_____________  Feet____________
RESTRICTIONS (To be completed by the inspector)
Open fires on the property and for the purpose stated on this application will be permissible subject to the following
restrictions indicated by an (x):

_____ 1.  Only material resulting from land clearing/demolition activities on 
          the property indicated on the application may be burned.  Garbage, 
          trash, or other refuse may not be burned.

_____ 2.  Material may not be allowed to smolder.

_____ 3.  Burning shall be conducted on during daylight hours.

_____ 4.  The use of tires, crankcase drainings and bituminous products
          for starting or continuing fires is prohibited.

_____ 5.  Burning shall be conducted at a minimum distance from neighboring
          occupied buildings or public thoroughfares, no less than shown in
          #5 on page one.

_____ 6.  Burning shall be conducted only when wind conditions are such that
          smoke emissions will not be carried in the direction of neighboring
          occupied buildings or public thoroughfares.

_____ 7.  Burning shall be conducted a maximum of one time.

_____ 8.  Burning may be conducted ONLY at the location indicated on property
          sketch above.

_____ 9.  Contact Fire Marshall or Central Alarm System (911).

_____10. Control burn is to be conducted by ______________ Vol. Fire Dept.

cc:  File
     911
     Fire Dept.

PREPARING YOUR SITE FOR A CONTROLLED BURN

• All asbestos siding must be removed
• Any lines connected to the building must be physically disconnected, in addition to having the service disconnected (including electric, phone and cable lines)
• Any tires in close proximity to the building must be removed
• Any paint, gas or other flammable products within or in close proximity to the building must be removed.  This would include any propane or oil tanks near the building.

In order to ensure that the proper building is inspected and burned, please mark the building door with and "x".

Please contact the Health Department at (443) 523-1730 when these requirements have been met.  At this time, the site will be inspected and the fire department involved will be contacted.  If any other preparations need to be made or problems arise, you will be contacted.