Burning Permit Application

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Burning Permit Application

<form-template>
	<fields>
		<field type="text" subtype="text" required="true" label="First Name" placeholder="First Name" class="form-control text-input" name="text-1597693694016"></field>
		<field type="text" subtype="text" required="true" label="Last Name" placeholder="Last Name" class="form-control text-input" name="text-1597693782363"></field>
		<field type="text" subtype="email" required="true" label="Email Address:" placeholder="Email Address" class="form-control text-input" name="text-1597693820665"></field>
		<field type="text" subtype="text" required="true" label="Cell Phone #:" placeholder="Cell Phone #" class="form-control text-input" name="text-1597693865800"></field>
		<field type="date" required="true" label="Date in which burn will happen:" class="form-control calendar" name="date-1597693892873" value="Date in which burn will happen"></field>
		<field type="text" subtype="text" required="true" label="Location of Burn" placeholder="Location of Burn" class="form-control text-input" name="text-1597693955249"></field>
		<field type="select" required="true" label="What Type of Permit?" placeholder="What Type of Permit?" class="form-control select" name="select-1597693982145">
			<option value="Open-Air" selected="true">Open-Air</option>
			<option value="FireWorks">FireWorks</option>
		</field>
		<field type="select" required="true" label="Location, Urban or Rural" placeholder="Location, Urban or Rural" class="form-control select" name="select-1597695425186">
			<option value="Urban" selected="true">Urban</option>
			<option value="Rural">Rural</option>
		</field>
		<field type="paragraph" subtype="p" label="If Urban please choose which Town. If Rural, which Fire Department" class="paragraph"></field>
		<field type="radio-group" required="true" label="Choose one" class="radio-group" name="radio-group-1597694322005">
			<option value="Town of Plumas " selected="true">Town of Plumas </option>
			<option value="Town of Langruth ">Town of Langruth </option>
			<option value="Town of Westbourne">Town of Westbourne</option>
			<option value="Town of Gladstone">Town of Gladstone</option>
			<option value="Lakeview Fire Dept">Lakeview Fire Dept</option>
			<option value="Plumas Fire Dept">Plumas Fire Dept</option>
			<option value="Westbourne-Gladstone Fire Dept">Westbourne-Gladstone Fire Dept</option>
		</field>
		<field type="textarea" label="Notes" placeholder="Notes" class="form-control text-area" name="textarea-1598647832625"></field>
		<field type="radio-group" label="Radio Group" class="radio-group" name="radio-group-1669223880776">
			<option value="option-1" selected="true">Option 1</option>
			<option value="option-2">Option 2</option>
		</field>
	</fields>
</form-template>

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