2. Open burning is prohibited without the use of an air curtain burner or trench burner.*

   I have read and understood the above statement.

   1. Yes
4. This Form must be Completed prior to Burn Ignition.
6. First Name*
7. Last Name*
9. Registration Contact Information
11. Address*
13. City*
14. Province*
15. Postal Code*
17. Telephone Number*
18. Email*
20. Fire Department*
    -- Select One --CaycuseChemainusCowichan BayCroftonDuncanHoneymoon BayLadysmithLake CowichanMalahatMaple BayMesachie LakeMill BayNorth OysterSahtlamShawnigan LakeNorth Cowichan (South End)Thetis IslandYoubou
22. Is this burning activity occuring as part of a potential development project?*

    1. Yes

    1. No
24. Organization/principal contractor responsible for development*
26. Name of development project*
28. Street Address of Burn site*
30. Legal Description of Burn site*
    Lot/Section/Range/Plan/District/Block
32. Contact Information During Burn
34. Name*
35. Telephone Number*
37. Estimated start of Burn*
    Estimated start of Burn
38. Estimated finish of Burn*
    Estimated finish of Burn
40. I am aware of the provisions regulating the open burning of landclearing debris as described in CVRD Bylaw No. 2020 - Landclearing Management Regulation Bylaw, 2009.*

    1. Yes
42. I have an air curtain burner/trench burner on site for burn.*

    1. Yes
44. I am aware of Provincial requirements related to open burning as described by the Open Burning Smoke Control Regulation, including the requirement to check the ventilation index before ignition.*

    1. Yes
46. I have checked for any restrictions on open burning, or the need to acquire a permit, with my local fire department.*

    1. Yes
48. I am planning to burn a Regulated Quantity of landclearing debris (equivalent to a Category 3 fire), and have obtained a burn registration number from Ministry of Forests and Range.*

    1. Yes
50. I will burn machine piled burning piles only.*

    1. Yes
52. I will notify the Cowichan Valley Regional District on the day that my burn will commence.*

    1. Yes
54. Register your burn with the Ministry of Forests and Range prior to ignition by calling 1.888.797.1717.
56. My burn registration number is:*

58. This Registration is Valid for a Period of 2 weeks from the date on Which it was Signed.

Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field