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r <br />i-t. <br />f r. ■ ' I <br />■ <br />PROHIBITED MATERIALS ARE: brush, oils, rubber, plastics, tires, building materials and chemically treated <br />materials such as railroad ties, treated lumber, composite shingles, tar paper, insulation, composition board, sheet rock, <br />wiring, paint, hazardous and industrial solid waste. <br />1 AGREE: <br />Not to bum any prohibited materials. <br />• Not to bum if there is a practical alternative method for disposal of material such as chipping or composting. <br />To use a clean burning device to start the fire. <br />Not to conduct burning during any air quality alert. <br />- Not to bum paper or cardboard except as provided under Minnesota Statutes 17.135. <br />To have this permit available at the bum site for inspection. <br />- That prevailing wind must be away from nearby occupied buildings and as far away from any highway or <br />public road and controlled so as that a trafTlc hazard is not created. <br />- To keep this fire under control and to assume responsibility for all damages and costs that may result from <br />burning done under this permit. <br />- That fires will not be allowed to smolder without flame. <br />- To provide a water supply and an adult to attend this fire until completely extinguished. <br />- To extinguish the fire immediately if this permit is revoked. <br />• That no material may be brought into be burned from another site. <br />This permit mav be revoked should anv or all of the following conditions exist: <br />1. A fire hazard exists or develops during the course of the bum. <br />2. A public safety hazard exists or may exist if the bum is implemented or is allowed to continue. <br />3. Any conditions agreed to have been violated. <br />REVOCATION OF THIS PERMIT WILL RESULT IN A 6 MONTH MORATORIUM ON ISSUANCE OF BURNING <br />PERMITS TO THE APPLICANT OR FOR OPEN BURNING AT THIS PROPERTY. <br />Signature <br />! ATTEST, BY MY SIGNATURE, THAT I HAVE READ AND WILL COMPLY WITH THE CONDITIONS OF, <br />AND ANY ATTACHMENTS TO THIS PERMIT; AND THAT I AM THE LANDOWNER OR HAVE <br />PERMISSION OF THE LANDOWNER TO BURN AT THE ABOVE BURN SITE LOCATION. I <br />ACKNOWLEDGE THAT VIOLATIONS OF PERMIT CONDITIONS MAY SUBJECT ME TO CRIMINAL <br />AND/OR CIVIL ACTIONS AND/OR REVOCATION OF BURN PERMIT PRIVILEGES IN THE FUTURE. <br />MAP <br />(Lot Size <br />Approved by:Inspected by:Date: <br />InspectorsComments:__________ <br />Fire Department: ____Long Lake Maple Plain Mound Wayzata <br />This ptrmit is valid for open burning as allowed and specified in Stale Statute 88.01 to 88.22, 88.75, 88.76, Minn. <br />Uniform Fire Code, and local ordinances. The permittee is granted permission to bum the above described <br />materials at the specified location during the dates listed above. <br />J