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2. 
4. Jenks Fire & Rescue
   1115 W 121st St
   Jenks, OK 74037
   918-298-1491
6. BURN PERMIT AGGREGATE STATEMENT
8. Date:*
   Date:
10. First Name*
11. Last Name*
13. Location of burn:*
15. I have applied for a Burn Permit and attest to the following:*

    1. At least one of the properties included in the permit process is zoned agriculture
    2. All properties are adjoining
    3. Total acreage is greater than 5 acres
    4. For the purpose of this burn permit application, all properties are managed as one parcel
    5. All vegetation is from the properties listed in the application
    6. All burning is for non-commercial reasons
17. Total Acreage of properties:*
19. Please Read Special Burn Minimum Requirements
    Special Burn - Minimum Requirements
21. As the manager of these properties I agree to follow all the guidelines in the burn permit application and agree to maintain control of the fire at all times. Further, I agree to pay for any damages or fees associated with the fire in the event Jenks Fire & Rescue must respond to control the fire.
23. 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.
25. Electronic Signature*
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field