<p> Town of Mendon 2282 US Route 4 Mendon, Vermont 05701 802-775-1662</p><p>Permit to Kindle Fire </p><p>Permit Number______</p><p>Written Permit Information</p><p>Name ______Date______(written permit is valid for 10 days) Address ______</p><p>______Requested date to burn______(must be within 10 days of written permit) Telephone ______</p><p>Exact location of requested fire on property: ______</p><p>______</p><p>Special Written Conditions (if required by Fire Warden):</p><p>______</p><p>______</p><p>______</p><p>I, the undersigned permittee, understand the law and my responsibility under this permit described on the back side of this permit.</p><p>______Permittee’s Signature</p><p>Verbal Approval Authorization (permit is not valid until verbal approval is granted by Fire Warden) Permission is hereby granted to ______to kindle a fire in accordance with Vermont State Forest laws (10 V.S.A. Chapter 83, Section 2645) at the above referenced location in the Town of Mendon on (date) ______until ______A.M./P.M.</p><p>______Warden’s Signature</p><p>This permit is granted under the following conditions: 1. This permit is valid only for the place and time verbally approved by the Fire Warden. 2. This permit in no way relieves the person to whom it is granted from any liability related to the fire or any damages it might cause. 3. The person setting the fire must at all times have sufficient help and tools present to control the fire. 4. Only natural wood material may be burned under this permit. Other materials burned require an Air Pollution permit as well as this permit. 5. The fire must not be left until it is entirely extinguished. 6. Restricted materials can not be used to ignite natural wood materials. 7. Any special conditions written on this permit are to be considered as part of “conditions to burn”. 8. If any permit condition is not followed, then the permit is immediately invalid and you will be burning illegally. 9. Violation of the conditions of this permit may result in the permitee receiving a “Vermont Fire Prevention Ticket” per State Statute which will result in court action and a fine for each day of violation. In addition, violations will be subject to the Town of Mendon Burn Permit Ordinance which could result in a civil fine up to $750.00. 10. If you do not understand the law or have further questions, contact your local forest fire warden before you burn. This permit can be canceled for cause at any time.</p><p>**This permit only valid with verbal approval of the Mendon Fire Warden on the day requested. FIRE WARDEN: Roy Prior 721 Journeys End 770-2101 Cellular Telephone Mendon, Vermont 05701</p><p>IMPORTANT!!!</p><p>IF YOUR FIRE ESCAPES!!! CALL 773-1812 Rutland City Fire Department or 911</p>