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2. Pottawatomie County Fire

   Jared Barnes, Fire Supervisor
   406C Miller Drive
   Wamego, KS 66547

   Ph: 785-457-3358

   Fx: 785-457-3359

4. First Name*
5. Last Name*
7. Company
9. Mailing Address*
10. City*
12. State*
13. Zip*
15. Mobile
16. Phone
17. Email
19. Date of Birth
20. Month*
21. Day*
22. Year*
24. Signature*
    By electronically signing this form you are agreeing to the validity of all information obtained within.
25. Date*
    Date
27. You will receive your burn permit number after your application is processed. If you have any questions, please call 785-457-3358. Thank you.
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29. Submit

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