HomeMy WebLinkAboutBurn Permit 4/09
t PLEASE CALL SCOTT COUNTY DISPATCH AT 952-445-1412 THE DAY YOU ARE GOING TO BURN.
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BURNING PERMIT FOR SCOTT COUNTY
PERMITTEE INFORMATION
BURNING PERMIT CONDITIONS (Check those that apply)
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Name LfiL K.LIJ;,~ [ n::j(ll
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Address ~:;-/-,;:; (rz~)t1, (.~( .2:'
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City rnl5Y Luk> StateJ1JJi Zip$;/.J..
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Phone # Or:.,'. ~ J.;"1' . Jr') (j"
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l( PILED MATERIAL (Clean Wood)
,(Specify) _1, J^ VI J "
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# Piles . ~ Approx. Pile Size
o RUNNING FIRE (Grassland)
Size of Area in Acres
Township
~ SPECIAL CQN,I;)ITIONS...., . ' /
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BURN SITE LOCATION
Address ;::-{'I) f"' :Oif/". ,J'r'" ,I~t:
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City T r it}! L.bLtt
To Be Completed
By Fire Dept.
EFFECTIVE DATES: From: M O'! 1001 IV ~ To: M or III 07 IV 0 'f
DAILY HOURS: From: AMIPM To: AM/PM OR ~ ALL DAY'
This permit is valid for open burning as allowed and specified in Minn. Rules 7005.0705 to 7005.0805, MS f 16, Minn. Uniform Fire code, and local
ordinances. The permittee is granted perrrission to burn the above described materilis at the specified location during the dates and times listed above.
I AGREE:
· To keep this fire under control and to assume responsibility for all damages and costs that may result from burning done under
this permit.
· To attend this fire until completely extinguished.
· Not to burn if there is a practical alternative method for disposal of the material such as chipping or composting.
· To use a clean burning device to start the fire.
· Not to conduct burning during any air quality alert.
· Not to burn paper or cardboard except as provided under Minnesota Statutes 17.135.
To extinguish the fire immediately if this permit is revoked.
· To have this permit available at the burn site for inspection.
· That prevailing wind must be away from nearby occupied buildings.
· That fires will not be allowed to smolder without flame.
FIRE SAFETY AND AIR QUALITY REQUIREMENTS
PROHIBITED MATERIALS ARE: oils, rubber, plastics, tires and chemically treated materials such as railroad ties,
treated lumber, composite shingles, tar paper, Insulation, composition board, sheet rock, wiring, paint, hazardous and
industrial solid waste.
VIOLATIONS OF PERMIT CONDITIONS MAY SUBJECT PERMITTEE TO CRIMINAL ANDIOR CIVIL ACTIONS.
REUSE, RECYCLE, AND COMPOST
I attest, by my s~at I have read and will comply with the conditions of, and any attachments to this permit; and that I am the
lan!~,wner or have permis1n of the landowner to burn at the above burn s7ocation.
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Permittee's SiQnature 'i,) Date I AoorovinQ Authoritv Sicr1ature
Mail form back to:
City of Prior Lake-Burn Permit
4646 Dakota St SE
Prior Lake, MN 55372
Date r/ - tv - ex;
Paid $25.00 permit fee )( Check #J.JOf....
or
o Cash
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