HomeMy WebLinkAboutBurn Permit - 10/04
PLEASE CALL SCOTT COUNTY DISPATCH AT 952-445-1412 THE DAY YOU ARE GOING TO BURN.
BURNING PERMIT FOR SCOTT COUNTY
Perm it # IS
~II or aMail
CALL 651-772-7930 NO MORE THAN 1 HOUR PRIOR TO BURNING
PERMITTEE INFORMATION
BURNING PERMIT CONDITIONS (Check those t hat apply)
Name ~eJU ~~('r~J
Address '&~(,4 ~CJk.(;J .},\
aty_Pr ('''rLttlq State H'-' Zip S5J7J
Phone # (PI 'J,-Ll/1- ~J..3 c)
ti: PILED MATERIAL (aean Wood.L .
(Specify) t"'\ \se WC)U{~ ~ ~ O,\/')h
# Piles;;) Ap p rox. Pile Size
o RUNNING FIRE (Grasslan d)
Size of Area in Acres
BURN SITE LOCATION
o SPEOAL CONDITIONS
Township Q.L.
Address 4~1) O~(( ,::>J-
aty Pt,'c>r ~t(l
EFFECTIVE DATES:
CAlLY HOURS:
I
Thlspermit isv.11d for open burning as e and specified in Minn. RIles 7005.0705 to 7005.0805, MSf16, Minnl Uniform Rre
r"' code, and local ordinances. The permittee is granted permission to burn the above described materials at the sp~cified location
-juring the dates and times listed above. :
FIRE SAFETY AND AIR QUAUTY REQUIREMENTS
IAGREE:
. To keep thisflre under control and to assume responsibility for all damages and coststhat mjiy result from
burning done under this perm it.
. 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
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 thispermit is revoked.
. To have this p~rmit available at the burn site for inspection.
. That prevailing wind must be away from nearby occupied buildings.
. That firesw..i11 not be allowed to smolder without flame.
PROHIBITED MATERIALS ARE oils, rubber, plastics, tires and 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 CRIMINAL AND/OR OVIL ACTIONS
REUSE, RECYa.E, AND COMPOST'
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.
-arm ittee' s Signature
\0 oJ 1-1
Date
}o /01-.3./0 If
. Date
Approving Authority Signature
Paid $25.00 perm it fee x{'01eck # 5~3 c( or
(J Cash
Mail form back to:
City of Prior Lake-Bum Permit
.16200 Eagle Creek Ave SE
Prior Lake, MN 55372
/.