HomeMy WebLinkAboutBurn Permit 2005
PLEASE CALL SCOTT COUNTY DISPATCH AT 952-445-1412 THE DAY YOU ARE GOING TO BURN.
BURNING PERMIT FOR SCOTT COUNTY
Perm it #3..;:;
JCaIl or oMail
CAll 651-772-7930 NO MORE THAN 1 HOUR PRIOR TO BURNING
.
.~ERMITTEE INFORMATION
Nam e f~ i., (ApekeJ. LL<;{o':-I6.J ~(V(Le:~
Ad d ress......-zl'1~<6 0t<-L5~.(...ouJ"" {1V<
at y PCM L"-.k.-... S1: at e 11/j,..! Zi P IT )IL
Phone# 1<,.,.-z~'N1- 1~(1
BURNING PERMIT CONDITIONS (Check those that apply)
CJ PILED MATERIAL (Oean Wood)
(Specify)
# Piles Approx. Pile Size
~NNING FIRE (Grassland)
Size of Area in Acres <.... \ ",,-L
BURN SITE LOCATION
CJ SPEaAL CONDITIONS
Township
Ad dress
~^d Poi /t+ t5>eqc h
~(I t.:> \ 0...u
aty
EFFECTIVE DATES From: M ()c{ /00<) /Y z.o." To: M DCO /0-,,,,, /Y t~'c~
DAILY HOURS From: AM/PM To: AM/PM OR )q1 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 perm ittee is granted perm ission to burn the above described materials at the specified location
Iring the dates and times listed above.
FIRE SAFETY AND AIR QUAUT'Y ~EQUIREMENTS
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 perm it.
. To attend this fire until completely extinguished.
. Not to burn if there isa practical alternative method for disposal of the material such aschipping or
com posting.
. 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 ext inguish t he fire im m ed iat ely if t his perm it is revoked.
. To have this permit available at the burn site for inspection.
. That prevailing wind must be away from nearby occupied buildings.
. That fireswill not be allowed to smolder without flame.
PROHIBITED MATERIALS ARE: 0 ils, ru b ber, plastics, t ires and chem ically treated materials such as railroad
ties, treated lumber, composite shingles, tar paper, insulation, comp.osition board, sheet rock, wiring,
paint, hazardous and industrial solid waste.
VIOLATIONS OF PERMIT CONDITIONS MAY SUBJECT PERMITTEE TO CRIMINAL AND/OR OVIL ACTIONS.
REUSE, RECYQE, AND COMPOST
I attest, by my signature, that I have read and will comply with the conditions of, and a~!Ilttachments to this
permit; and that I am the landowner or have permission of the landowner to burn t thl above burn site location.
/~-/ A' ~ I /
~~ 7;itd'/ZO%.~.__ ~.[~ /I,fv.lo~
rm ittee-s Slgnature " ~pprOVing 1\o1horfty (D~
Paid $25.00 perm it fee 0 O1eck #
or
~sh
Mail form back to:
City of Prior Lake-Burn Permit
16200 Eagle Creek Ave SE
Prior Lake, MN 55372
AFr 01 05 02:41F
DNR WEST METRO FFICE
(952)826-6767
F.2
~ fl3/3fl/2e05 15:44 51388978541
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PAGE 134
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