HomeMy WebLinkAboutBurn Permit - 6/04
HEPHERD OF THE LAkE
PAGE 01
E DAY YOU ARE GOING TO BURN.
Permit #~
NO MORE THAN 1 HOUR PRIOR TO BURNING
CJCaI! or oMall
_.
PERMITTEE INFORMATION
BURNING PERM IT FOR SCOTT COUNTY
BURNING PERMIT CONDITIONS (Chick those that apply)
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Nam e La u -tI..J! 'y &V1 C_-"1'-l rct.-,
Add ressr /17UJ Mc."t~ ~ "tel. P. d .
atyR"'oy),ate aate/1a.. Zip !J~:;79"
Ph 0 n e # c; 5J. -d-30 - t?9/6
. PILED MATERIAL (Oean Wood)
(~ecjfy) ~ecss &/(d /~ SUQfS
# PIles 10- tJ- Apprcrl<. Pile Sze .y.x f?
rt'IAfel','....1 ~ ~e.h'1Cll"';j of? t"()."" <!.c ~fN,.( c..'fy'o ~
o RUNNING FIRE (Grassland)
Size of Area in Acres
aty
EFFECTIVE DATES:
DAILY HOURS:
9>,tJ ~5-
. . ~ e,..eM
BURN SITE LOCATION
Township
Address
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This psrmllls valid for open b luning u ~"o.wed and specified in Minn. Rulss 7005.0705 to 7005.0805, MS f 16. Minn. Uniform Fire
code. and local ordinances. The permit lee is granted perm Isslon t.o b urn the above described materials 8t the specified location
during the detes and rim es listed abolls.
L,IAGREE: FIRE~FETY AND AIR QUAUTY REQUIREMENTS
V. · To keep thlsflre under control and to assume responsibility for all dam ages and costslhat may result from
burning done under thispermit.
. To attend 1 his fire until com pletely ex! inguished.
. Not to burn if there is a practical alternative method for disposal of the malerial 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 10 burn paper or cardboard except asprovided under Minnesota 8talutes 17.135.
. To ext inguish t he fire ;m m ed iat ely jf 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 nol be aHowed to smolder without flame.
PROHIBITED MATERIALS ARE: oils, rub be.r, plastics, tires an d chern ically 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 ~MINAL AND/OR aVlL ACTIONS,
REUSE, RECYCLE, AND COMP05r
I atte$t, by my $ignature, that I have read and will comply with the conditions of, and any attach ents to this
permit: and that I am the landowner or have permission of the landowner to burn at t e abo~ burn site location,
~~ ~h '
'firm itt ee' !l Slgnat u re
Mail form back to:
o r CJ Cash City of Prior Lake-Burn Permit
. fs r 16200 Eagle Creek Ave SE
d ttK. '/41- Y-;l.. II S- __~rIQr Lake, M N 55372