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2. 
4. Name*
5. Phone Number (include dashes)*
7. Address*
8. Email Address*
10. City*
11. State*
12. Zip Code*
14. Burn Site Address*
16. Type of Materials to be Burned*
18. Equipment Used to Control / Extinguish Fire*
20. Number of Piles to be Burned*
21. Size of Pile(s) to be Burned*
23. Type of Burn Permit*
    -- Select One --Commercial Property ($200 Fee)Lot Clearing Multi Family ($50 Fee)Trimming / Storm Damage (No Fee)
25. Use Type: Residential/Commercial *
    -- Select One --Single (101)Single Attached (102)Two-Family (103)3-4 Family (104)5 or More (105)Condo (106)Hotel, Motel (213)Garage, Carport, Shed (438)Mobile Home (401)Amusement, Recreational (318)Church, Other Religious (319)Industrial (320)Parking Garage (321)Service Station, Repair Garage (322)Hospital, Institutional (323)Office, Bank, Professional (324)Public Utility (325)Schools, Other Educational (326)Stores, Mercantile (327)Other Nonresidential (328)Structure other than Building (329)
27. Agreements/Acknowledgements *

    By checking this box, I understand that the burning site and pile shall be CONSTANTLY attended by a responsible adult AT ALL TIMES until the fire is completely extinguished, NO EXCEPTIONS.

    I understand that smoke from the burning process shall not obscure any street, highway, or create a public nuisance at any time.

    I understand that burning shall consist of trees, brush, or other natural products ONLY. No rubber, asphalt shingles, tires, construction debris, painted, stained, varnished, or chemically treated lumber, garbage, etc.

    I understand that burning piles shall not be located within 100 feet of any structure owned by the permit holder or within 200 feet of any structure not owned by the permit holder.

    I understand that a suitable means of controlling or extinguishing the fire must be available at all times. This may be accomplished by use of a water hose, shovel and dirt or sand, fire extinguisher or heavy equipment.

    I understand that burning permits may be suspended by the Fire Chief, Fire Marshal, any Firefighter, DNR employee, or other peace officer if local weather conditions warrant or if nuisance calls are received.

    I understand that open burning is prohibited when burning restrictions or bans are in place and I will check the DNR website for this information prior to burning at Fire Danger and Burn Restrictions

    1. I agree.
29. Agreement*

    By checking this box, I agree to contact the Winona County Sheriffs office at 507-457-6492 to notify of the burning before the fire is started.

    1. I agree.
31. Agreement*

    By checking this box, I hereby apply for an open burning permit and acknowledge that the information above is complete and accurate. I understand that this is not a permit but only the application for a permit and work is not to start without a permit. I understand that the permit will be emailed to me at the email provided once the application is approved.

    1. I agree.
33. Payment Agreement*

    By Checking this box, I understand that I will receive an invoice sent to the email provided and when I receive this invoice I agree to call and make a payment by phone to the City of Winona finance department at 507-457-8262 in reference to the invoice number and I understand that I will not receive a permit until the invoice is paid in full. 

    1. I agree.
35. 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.
37. Electronic Signature*
Leave This Blank:


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

    This field is not part of the form submission.

41. Submit

* indicates a required field