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

    1. Yes

    1. No
22. Organization/principal contractor responsible for development*
24. Name of development project*
26. Street Address of Burn site*
28. Legal Description of Burn site*
    Lot/Section/Range/Plan/District/Block
30. Contact Information During Burn
32. Name*
33. Telephone Number*
35. Estimated start of Burn*
    Estimated start of Burn
36. Estimated finish of Burn*
    Estimated finish of Burn
38. Applicant Checklist*

    1. 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.
    2. 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.
    3. 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.
    4. I have checked for any restrictions on open burning, or the need to aquire a permit, with my local fire department.
    5. I will notify the CVRD upon commencing the burn.
    6. I have an air curtain burner/trench burner on site for burn.
    7. I will burn machine piled burning piles only.
    8. I will notify the Cowichan Valley Regional District on the day that my burn will commence.
40. Register your burn with the Ministry of Forests and Range prior to ignition by calling 1.888.797.1717.
42. My burn registration number is:*
44. This Registration is Valid for a Period of 3 Months from the date on Which it was Signed.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field