*From Burlington BOH Protocol Form. This form must be submitted for every protocol.
**Note: Discussion of Permit Approval will be placed on a regularly scheduled BOH meeting agenda by the Director of Public Health when BOH staff has completed application review of submitted materials and all information has been received.
Please upload any additional attachments to include with application.
By signing below I hereby certify:
This is an electronic signature to submit your application, there is no need to print or download this form for a physical signature.
This field is not part of the form submission.
* indicates a required field