HomeMy WebLinkAboutBurn Permit - 9/06
~ PLEASE CALL SCOTT COUNTY DISPATCH AT 952-445-1412 THE DAY YOU ARE GOING .TO BURN.
:#cALI.'51.772.1'930 NO ..qRET~R10R TO !lURNlNG
(p1-e~ck:..- (lISkr -kriJe, bOtt-n ftCiW'S PERMIT FOR SCOTT COUNTY
Permit # ~
~or OMail
,~ "ERMITTEE INFORMATION
BURNING PERMIT CONDITIONS (Check those that apply)
Name f/I! I ~ ()1 "K;J /0
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Address I (p ~f.o f mJb~h,tAJtJ (2)
City p~fl, h41<~ State mtlziP 6537~'
Phone # tiLt 0 r (~ab
[J PILED MATERIAL (Clean Wood)
(Specify) f>~
# Piles r Approx. Pile Size "'1' j.. <I
[J RUNNING FIRE (GrasslancO
Size of Area in Acres
BURN SITE LOCATION
[J SPECIAL CONDITIONS
Township
City
\ toq V t rvtJv ~~N
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Address
EFFECTIVE DATES: From: M~D ~N O&;
DAILY HOURS: From: -1.i... AM/E>M)
To: M JO /D Q.~No(P
To: ~(AM)'PM OR [J ALL DAY
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his permit is valid for open burning as allowed and specified in Minn. Rules 7005.0705 to 7005.0805, MS f16, 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.
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 practical alternative method for disposal of the material such as Qhipping 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 extinguish the fire immediately if this permit is revoked.
. To have this permit 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, rubberJ plastics, tires and chemically 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 CIVIL ACTIONS.
REUSE, RECYCLE, AND COMPOST
I attest, by my signature, that I have read and will comply with the conditions of, and any attachments to this pennit; and that I am the
landowner or have pennission of the landowner to bum at the above bum site location. .
I --fjfk fh4
I Permittee's Signature
~ CUQ:;)
Date t) , J./ -OJ.,, Approving Authority Signature
DatU ~
Paid $25.00 permit f~ Check #
or ~ash
fJ-tIb
Mail form back to:
City of Prior Lake-Burn Permit
16200 Eagle Creek Ave SE
Prinr I ....... MI\I ~~'t7?