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2. Contact Information
4. Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
17. Burn Location
19. Burn Address*
21. City*
22. State*
23. Zip Code*
27. How would you like to receive your permit?*

    Email: Cosumnes Community Services District will send the burn permit to the email address listed in this application and may occasionally email important notifications such as expiration dates and next year’s application. Your email address will not be used for marketing purposes.

    OR

    Mail: Cosumnes Community Services District will send the burn permit through the U.S. Mail. There is no in-person pick-up. You will not receive email notifications or reminders.

    1. Email

    1. Mail
29. Electronic Signature*

    I have checked the Burn Area Map and am in an Open Area or Limited Burn Area. I understand that I am not eligible for a refund if I am in a No Burn area. Once your application is submitted, you will receive verification within 3-5 business days. Verified applications will receive a link for payment via email.

    1. Agree
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field