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Permit number:
Issued By:
___________________________________________________________________________
Permit Application Date:
Permit
Expiration Date:
___________________________________________________________________________
Applicants Name:
Phone
Number:
Mailing Address:
___________________________________________________________________________
Land Owners
Name: Phone
Number:
Mailing Address:
___________________________________________________________________________
Physical Address of Burn Site:
___________________________________________________________________________
Location of, and Directions to Burn Site:
__________________________________________________________________________________________
By signing this permit
application, I acknowledge that I have received a copy of the
City of Lowry Crossing Burn Rules, I understand them, and I
agree to follow them.
I also
understand that authorization to conduct outdoor burning or the
use of fireworks does not exempt or excuse a person from the
responsibility, consequences, damages, or injuries resulting
from the authorized burning or fireworks use, and does not
excuse a person from complying with any other applicable laws,
ordinances, or regulations.
Signed
By:________________________________________
Date:___________________
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