HomeMy WebLinkAboutBurn Permit - 10/04
>FPLEASE CALL SCOTT COUNTY DISPATCH AT 952-445-1412 THE DAY YOU ARE GOING TO BURN.
BURNING PERM IT FOR SCOTT COUNTY
Permit # /a5
-,QCaIl or oMail
CALL 651-772-7930 NO MORE THAN 1 HOUR PRIOR TO BURNING
rERMITTEE INFORMATION
BURNING PERMIT CONDITIONS (Check those that apply)
Nam e 0 fi(,.U {I.J.
Address ..t&1~
fR..l of-
Oty ~ State/YIN zip5S3ia---
Phone # '15if- 44-1-hla...l
~/N. &
Q-A-(ZLNooP C-lR- S E
Jij PILED MATERIAL (aean, Woo~) ~
(Specify) -lttA....-tJL ~
# Piles. Approx. Pile Sze
CJ RUNNING FIRE (Grasslan d)
Size of Area in Acres
.
BURN SITE LOCATION
o SPEaAL CONDITIONS
Township
Address
Oty
EFFECTIVE DATES
DAILY HOURS:
30'.'f~
PM
IY~
OR ... ALLDAY
Thispermit is valid for open burning as allowed and specified in Minn. RJles 7005.0705 to 7005.0805, MS f 16, Minn. Uniform Rre
~de, and local ordinances. The permittee is granted permission to burn the above described materials at the sp clfied location
. ring the dates and timesl/sted abo,!e.
;J(:- I AGREE: FIRE SAFETY A'NO AIR QUAUTY REQUIREMENTS i
. To keep thisfire under control and to assume responsibility for all damages and costs that m~y result from
burning done under this permit.
. 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
composting.
. 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 the fire im mediately if this perm it is revoked.
. To have thisp~rmit 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.
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 rQck, wiring,
paint, hazardous and industrial solid waste.
VIOLATIONS OF PERMIT CONDITIONS MAY SUBJECT PERMITTEE TO CRIMINALAND/OR aVlLACTlONS
REUSE, RECYQ.E, AND COMP05r
I attest, by my signature, that I have re&J 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.
10 .....0..8-.1) 4::..
Date
. .~~U6) /0-;;'9-0tj
APprOvi~thoritY Signature - Date
Paid $25.00 perm it fee )Q Oleck # 37tt3 or 0 Cash
Mail form back to:
City of Prior Lake-Burn Permit
.16200 Eagle Creek Ave SE
Prior Lake, MN 55372