HomeMy WebLinkAboutBurn Permit -5/04
PLEASE CALL SCOTT COUNTY DISPATCH AT 952-445-1412 THE DAY YOU ARE GOING TO BURN.
BURNING PERMIT FOR SCOTT COUNTY
Perm it # 61
..creall or QMail
CALL 651-772-7930 NO MORE THAN 1 HOUR PRIOR TO BURNING
PERMITTEE INFORMATION
BURNING PERMIT CONDITIONS (Check those that apply)
Name W MvJ\~ M~'SkR-
Address ;;).,70 JgD~ SJ-. E ~ ,
atypr;of ~ StatlV\~zip 5"S37L
Phone # C?s-2-l/t./7-8/71'
Cl RUNNING FIRE (Grasslan d)
Size of Area in Acres
BURN SITE LOCATION
[J SPEOAL CONDITIONS
Township
~~/
Address
aty
EFFECTIVE DATES:
DAILY HOURS:
[J ALL DAY
This permit is valid for open burning as allowed and specified in Minn. RJles 7005.0705 to 7005.0805, MS.f 16, Minn. Uniform Fire
-code. and local ordinances. The permittee is granted permission to burn the above described materials at the specified location
uring the dates and times listed above.
I AGREE:
. To keep thisfire under control and to assume responsibility for all damages and costs that may result from
burning done under thispermit.
. To attend thisfire until <<ompletely extinguished.
. Not to burn if there is a practical alternative method for disposal of the material such as chipping 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 Satutes 17.135.
. To extinguish the fire immediately if this permit is revoked.
. To have this perm it 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 QUAUTY REQUIREMENTS
,
PROHIBITED MATERIALS ARE: oils, rub ber, plastics, t ires and chem ically treated materials such as railroad
ties, treated lumber, composite shingles, tar paper, insulation, composition board, sheet rock, wiring,
'oaint, hazardous and industrial solid waste.
JlOLATIONS OF PERMIT CONDITIONS MAY SUBJEcr PERMITTEE TO CRIMINAL AND/OR OVlL AcrlONS
REUSE, RECVQE, AND COMPOsr
I attest, by my signature, that I have read and will comply with the conditions of, and any attachments to this
permit; and that I am the landowner or have permission of the landowner to burn at the above burn site location.
5/5/1/lf
Date
r-!cr~
Date
Approving Authority Signature
Paid $25.00perm it fee )s(Check # 1~S-D3 or 0 Cash
Mail form back to:
City of Prior Lake-Burn Permit
16200 Eagle Creek Ave SE
Prior Lake, MN 55372