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PERMIll.1!.E INFORMA nON
'BURNING PERMIT FOR SCOTT COUNTY
Name C' ~'<t' /"''->-/ (), ~ 0
Address dS Lj _1 I) a Hz:; 'i 0.. 1- to\' ( (
City flL"()(\ AC4lJ~ StateJ1fi:LZip"oS537';,
Telephone Number ,:/'YC: - S /9/
BURN SITE LOCATION .
t/.2..lr ('~.> ~t.l.~ c..Jlf.lIJ
Township ~Co1f ~(' ,"co I:aif;)
Address 1'7' D ?f\) fJ; h ~ iaH {J itRJ. {
City ~ f' La 11 Y'
I . S1~S-"" )'/79
.(,. / /I.~
. EFFECnVEDATES: From: M-!/lJDJLJY7'1
DAILY HOURS: From: ~
BURNING PERMIT CONDITIONS (Cbeck tbose tbat apply)
o PILED MATERIAL (Circle Fue~~ Leaves / Other
(Specify)
# Piles -L""~ ~ Approx. Pile Size -1.0 y J{.'"")
Cl RUNNING FIRE (Circle Fuel) Brush / Slash / Grass
Size of Area in Acres
Cl FARM OPERA nON Household / Other (Specify)
Cl SPECIAL CONDITIONS
Cl AITACHMENT
Cl WETI..AND
/ -?~ O~
To: M~">V IY }' '/
To:. ? ~ OR" Cl ALLDAY
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 permission to bum the above described materials at the specified location
during the dates and times listed above,
r attest, by my signature, that I have read and will comply with the conditions o/" and any attachments to (piS R it; and that I am the
.andowner or have permission of the landowner to burn at the above burn sit ation. rJ.
/I /1
/%~/eL .~ u:('" 0/~/~7 ~/l,// ~'I' 6-.6~fj7
Permittee's Si~nature ) Date A6provbtglAuthority Signanr \..,../ ,/ Date
FIRE SAFETY AND AIR QUALITY REQUIREMENTS
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 pra~tical alternatIve method for disposal of the material such as chipping or composting.
· To use a clean burnmg deVice to start the fire. .
· Not to conduct burning during any air quality alert.
· Not to burn pal'er or cardboard except as provided under Minnesota Statutes 17.13 5.
· To extinguish the fire immediately if this permit is revoked.
· To have this permit available at the burn site for inspection.
· That prevailing wind m.ust be away from nearby occupied buildings.
· That fires will not be allowed to smolder without flame.
PROHIBITED MATERIALS ARE: oils, rubber, p'lastics, tires and chemically' treated materials such as railroad ties
treated )umb~rl composite shingles, tar paper, insulation, composition board, sheet rock, wiring, paint, hazardous and
mdustrlal soha waste.
VIOLATIONS OF PERMIT CONDITIONS MAY SUBJECT PER~'ll11tt TO CRIMINAL AND/OR CIVIL
CTIONS.
REUSE, RECYCLE, AND COMPOST
BURNPRMT,DOC
Revised 412196