2. Applicant Name*
4. Address*
6. City
7. State
8. Zip Code
10. Phone Number*
11. Email Address*
13. Name of organization applying for permit to explode fireworks:*
15. Name of person or organization that shall be the operator or operators of exploding the fireworks:*
17. List previous experience of the operator or operators in exploding the fireworks:*
19. Has the operator or operators had any training in exploding fireworks?*

    1. Yes

    1. No
21. If so, what has this consisted of?
23. Date(s) on which the fireworks display shall take place:*
25. Location at which the fireworks shall be exploded:*
27. City
28. State
29. Zip Code
31. Will any emergency medical treatment be available at the location of where the fireworks will be displayed?*

    1. Yes

    1. No
33. If so, what will this consist of?
35. Will any fire protection be available at the location of the fireworks display?*

    1. Yes

    1. No
37. If so, what will this consist of?
39. Will you notify your local fire department regarding the date, time, and location of the fireworks display?*

    1. Yes

    1. No
41. Will any search be conducted after the fireworks display for unexploded fireworks?*

    1. Yes

    1. No
43. Will people be restricted from the area until the search is completed?*

    1. Yes

    1. No
45. Will the location where the fireworks display is conducted be wetted down after the fireworks display?*

    1. Yes

    1. No
47. Will the operator and the permitee be covered by insurance for their fireworks display?*

    1. Yes

    1. No
49. Iowa Code Section
    Iowa Code Section 331.304(9) and Section 727.2, allow fireworks permits but (1) only upon an application made in writing; (2) only to municipalities, fair associations, amusement parks, and other organizations or groups of individuals approved by the County Board of Supervisors; (3) and only when the fireworks display will be handled by a competent operator.
    
    These two statutes do not allow a County Board of Supervisors to issue a permit to an individual person.
51. If your area is under burn ban on the planned date of your fireworks display, this permit is void.
53. Applicant Signature*
54. Date*
    Date
58. Submit Completed Application

    Submit applications by United States Postal Service to:

    Hardin County Board of Supervisors

    1215 Edgington Avenue, Suite 1

    Eldora, IA 50627

    
    

    Submit completed application by fax to:

    Fax: 641-939-8223

    
    

    Submit completed application by email to:

    Jolene Pieters, jpieters@hardincountyia.gov

Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit Submit and Print

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