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7/50 P.O. Box 66, Crystal Bay, MN 55323 <br /> 30 Minute notice shall be given to the police department prior to burning- <br /> - ? (0q 525-6210 <br /> Expires after 30 days from date issued. <br /> OPEN• <br /> BURNING� � PERMIT <br /> SITE ADDRESS: ✓?��0 0 Mta 0 01-< 1 1`��� D,e/j)ATE: ‘o aC <br /> km'm ; OS 10/q(\) .S 3o/1.0 <br /> Name: Phone: (h) ‘1:y5--- <br /> � (o) <br /> Mailing Address: ,.S4 but, a') Sf re City: Korn C zip: c5.3C <br /> Agent (if applicable) : <br /> FOR THE PURPOSE OF BURNING ��cS Y1 (u m fir' <br /> This application for open burning will be accomplished in accordance with <br /> the conditions listed. The recipient of the permit shall comply with all <br /> other state and local laws regarding open burning including obtaining the <br /> required permits. (NOTE: More than 5 times per year (-for all <br /> organizations and individuals regardless of tax status) will be charged a <br /> $100.00 annual fee. ) <br /> Permits are issued for disposal of trees ka4.4. <br /> & brush only. Burning of garbage, <br /> trash, leaves, etc is not allowed. Signature <br /> Approved by: Inspected by: <br /> ( N)/j'//gyp/ Date: ;7g el) <br /> Inspectors Comments: tr' _ <br /> V <br /> Fire Department: (ng Lake ) Maple Plain Mound Wayzata <br /> The Fire Department must sign this burning permit if they will be doing the <br /> burning for the applicant. <br /> Fire Department <br /> THE FOLLOWING ITEMS are to be completed before the inspector arrives (If inspector has to', <br /> re-inspect site because items were not complete, there will be a $20.00 charge per re- <br /> inspection): <br /> 1. Street address must be posted and visible from the street. Where more than one house <br /> is served by the same private driveway or _unnamed private road, additional sets of <br /> numbers shall be placed at every fork or other driveway as necessary to direct <br /> traffic to every house including the house farthest from the street. <br /> 2. Burn pile must be stacked at burn site meeting the following: <br /> - Trees & brush only <br /> - Minimum 50' from buildings <br /> - 8' maximum diameter, 4 high maximum <br /> 3. Draw a map on back side of permit application locating the burn pile. <br /> 4. If these conditions are not met, the permit will be denied and you may not apply for <br /> another permit for 30 days. <br /> 5. Read all conditions on backside of permit before burning. Violations of these <br /> conditions may result in the issuance of citations and permit may be revoked. <br /> ALL SITES WILL BE INSPECTED before issuance of burning permit, subject to <br /> availability of staff time. <br />