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<br /> I IIIA" 'IIIN I 'IIIN T IL T ' ;III II IIIRIEN w' APPROVAL '' IIII!!!; UTION
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<br /> .....,,.... .. ...........,.. ...._...............,...............................,...................II,. ..........
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<br /> CI"T"Y AIS I ' JII, COMITY I
<br /> located ul'lll„hi n city fl. Bits tocalted in a townthiIjjp
<br /> �Ilt.;�
<br /> f",• Name. ............... �..
<br /> ...................................................................... ........................................................................._...._._..._..._�.�. �rPu..nl:'nty Nrr'nm ...........................................
<br /> DateApproved by Oty CIrntnc'l ,
<br /> ......... tttn rP�autM Boarnt,
<br /> ........................................................... ......................._ . �.................. V,
<br /> _ u
<br /> uIRes'ruli:Ubo,,.0 INII,uirnbeir'n ..................................................................................................................................................................®................... Res,oll'tult',tc.m II%.irrnber,..^ .... ......... .., ....................... _............................................................
<br /> �,(If rncnrne,r attach mee
<br /> tirIg Imnilrnu,ntes,) (H none,attach meetingIminutes.)
<br /> &g naatdIrk''uWCit it:::!'II•'silnllklln'k:!".II'I Signature of Ck9Klllf"EISA/ IPrr,.IY"voinll-iiek
<br /> �... ................................—_..----._.............m._....................... II
<br /> P.
<br /> Ij"ntW ; .. Date&S I4w ... � � dile: .................... l:)at�n Sligrfie .........
<br /> TOWNSHIP NAME:
<br /> a
<br /> 'otni Bete bellow only'ulf required :ibv anis county
<br /> „
<br /> LocWl o-fl
<br /> "I��i 11 r IIXFthetcmnshllp, I urprow[(,dgthat the h)IIgnni trrin is s
<br /> ttlV, ts,Musf ` township hasrlosiatuthaauthoirl � vit deny
<br /> � pl t , SVa349 �� � � u
<br /> Priitnt'rrlrwnsh",a N . ................. ......................................................... ............_lil
<br /> u l tt�u'trnt:^', I
<br /> U
<br /> 'iignn Lure d:alf,...t"b tn~I[1p lceir. ....................................................................................................................................................................................................
<br /> I.."Ilde ........., .__........-___ ._____._--.._. _.. Date Signed:: ... __.. _ .., .,_. ........
<br /> W GinIVNirr AND OATH
<br /> $. I tiner by contni':*,nn't that bcaN 9 a'w erii1forceirwrient officers, ESP I assuirnefi,.111 nresp4.AI1sIIIIDflIIty"fur the ta, !"and awIfull d:DoIXwrat;VIX:U n olf
<br /> the Boatd c:ir Nt s a giernt's, aII'nd the a;.:'ul'n'nY"9"iss� o neirs of a fl aC;JvIltll'es to boR'nidIW tert,,t,.
<br /> iarx.1 th 'Illr a�r�,'dall'ntss' II'n"Ilrca,y' C�Irnt�lt
<br /> f 7. i. nrilillllPNrr'nliuuau°Iie IXnn^ rYi 'nllrtp'n thn::; Vs ra 'k rnrnacutaa
<br /> Ir�"�a'�rduu�ra iAu`I nitnll"a ilr`
<br /> anct Vlln''l i t tInIX* BBa Hrnq a ��p1�'�'llllll n��,��fnit:Diilknig a nl1Y rut es o thio Bm-.ill d �rV d agree,w eh u
<br /> 2. the IBcaairdl zanid uts agent, a aancl tlliie rGM iisslio ne= n.AN to al.Oide Ihny t line taws and r r.ulln., „ I ci..authng acme ndi nlentsl'to V
<br /> revenue and tia.,vb'c safety and tiheh,agents, a.,ir a theirn,
<br /> allathtn,.i e Id to inspect: the baannl!'c riecr.iirds of the garnnta'lurng
<br /> account hiere'ven ncestY" to
<br /> ta "Cuu'lII' I"ertn dad Any tage :nIaplEn tarr NNforni"t an nNLPe submitted
<br /> Ystk"➢e
<br /> curr lnt garttunn and paw, Boarid s:w rcays a#"t "tie change has taken
<br /> effect
<br /> t have reap this and aill ilult'rirrnnatutan...l
<br /> 9, 1. un �I rtard `I Fare o p
<br /> rcidle re uNred iliforrnation or
<br /> uulttt ha t , ens true ra atai7Cnn9'I �tn.
<br /> par 'n��uatNu taus � II'rivaNlleiI.W'�m PEntnlPil IulLu u��n Irn y res :L pinl tlln
<br /> ,, A'VN requlr'e�ct 'Vn#"dar'imab ucn has t:eeri t'II..ifly& c;Niralse'i . de null or Y° vt'i»'aUicin o,f i hive nse.
<br /> 5, 1 gain; the cNni! t execu'Livat officer of thie u.tu paamniiz.aat°icn, 10. U unrardm^rstatlnlr9 'koie fee ps 'noxa IIpfuundaabl,e rIX g;.,illndW s's of Hce nsie +
<br /> pru�iuruv all/c enla9.
<br /> a iI
<br /> t
<br /> ..............................................
<br /> ................................................................... Ii n W �......m....
<br /> ateSignature n � Officer" t. n ,, nt)
<br /> Pca
<br /> .......�.,..�.................. . ..........................�.m........
<br /> ..........___........................................................................................................................ ....................................................................................................................... ........................
<br /> Data c�rA'vea mm'",r�m':The�
<br /> �iLiested conn this'!rris uPwt�e:an�m a'U rrA'�rlhielrrr I receivedIbq i �oa.a�r�t. M'Irnesota s�Deaa'rtme°a, �t r•�ulbl:nr'Srafety, M
<br /> Irnt''asN°rm�,'tnNumP ��
<br /> form (and�A n'y at'taclhrann.nb.;)'o�wiinn e Used it the Aid of ij::Pr Ivrttur.rrnaa�dor j:,)rcBAdtr!ed wilt! I e ln.oirni ry� c,�•�icul p% �;;:��mm sii IN°i�N'rs ihila!:" b.ltl g''"�C911'n!troil Wa,A�I'd(1130.k°•. ,t,��o Ctl:�n:err Illlp yc,;III` i,Gll!vafite data r;.ItniCoiut',yo:lull..ogja e.atilo Vi II�Y""o,',t J�k.�tN�C.i N'1fl�"'' r��iIX:!Vtl� M in I"Vf.^h'ota tWtaragexent:,,&
<br /> it ,p�all'nn'ck'tid"PrP'". u u
<br /> to b,e Vrnv+opi ed tlo Ca'N'yfW the Board i the permit va''nnelli tt,a Budget,, ai?d Rjeve n�,je,terg,,:mauve A.la".,n��td:,,
<br /> I, Irjl'tl'tl'a:i°HVS�.aictlivinµaspllta ntit,lrimesot.a. Your o8"call'S11:zaat�ic1."n ha3s Board is&,e°,s ttWe p.,v'79t,kllt l."nf�rmiatkjiri 'natl,irAlnaii aird gari'una'�Ipant„
<br /> the ruil ht, a,".Iretdi e to ?&l.pp"iy iIJt e Ilinformaa't o n,N tWfq'ViMwirn'a<&'7r pirovilrted a."I!:�Ibi::.IG!ome Dub:r a,t n:Pnl.Nnorcurd reiY,nll.iat,C iry zn'gC:.'IWiI:ies; a,'nv^Dne pa rsl.arll;to
<br /> {Ir y r,..v r n t" s u�; , e aN- II rm a . . a r "r!yl'" .
<br /> �a'a&a'r ar��"'s d�iataro�N nw"t'WVae�to :+0.11 aat t�"Ra..m V i�lp'�C'II'II'IIaH'@:I�V�n* �r".iF'"m�e1ax"::�xG'UN�:ak permt,a u V""'ta.,ti, �it�d.A"'" C'f114",'d"t Gyl"�„tX.t Ckt �„Y N�M�hI:eVN.t��d�l'�"�'�Il'C & IX�°"IN"Ild.i^'a•
<br /> A.hi:,Shc wd inay not be ab'M to eetei m!i e your, porvkle�d rerna�pllis PrqNFatea a.'M`�Pn the spec�:Ifl eP y va'ut o .Pe'd by state m, fed ral !a:,avv h
<br /> and,as a ;.N':^II&.�egiiVence, �"',xcepu:io of ra"IX:Vp.:' P.Arga:ilza w""fr'V'!s 8'narrie manG to have access Uo°II.!!:inroIr liat'rcri; PY IId,)taliidi@a:�S
<br /> MVV reAa,w tic uSs,Ue n penrr?,t:.II:IF vod orgaar"za't= adn.re!;s which'IMM nerria.nn"1'ubllnC:- PrNvaatC' avid a'ar"enii.Hios tilt hlhlld:;,6"':til as A degal a„,Id"cit
<br /> Vw, " m ^r,l r.' r"`m' v the IiYrrS �{ „°in'B qtr”' &&'a't'a �gltPif7l.h','aY.Y..N�Y":.nlanlrii'a:''t:'mtln a1", ah,a`�al'eitlln.at' ;,"". a�
<br /> .P��ies t ne %'"a aYll..�at.edn Y"Y,?' &NRrlau�il.Q, �. W 'pC4fllln':x, 'a "'81!i r,a,.:g aIV'aa..6U"' i!o'r
<br /> tntat na D!" b,&"ala p0.Aii..Vi C'?"'Vtd9 n'',Y n!n:'V G° aY.PnPE', uMtV.Ni. "ati:Av..Vlr to: Board rnerribers,, i staff 'N1ri0.Al ie ;Yrr'„natRNn!I"W t 1 V.l Vl'„"i II'nIXadnr['", a �iM1PCr',” a:Y :l
<br /> ...erga.Nll'nllza on.n,nar e and'acdir ircrils ahw�V'nl t e t'Pl:A llc 'i'9A�ork Ir&�:"'qWi es access t',1 t�NVe��mteh"'rrd'rn'"„',;tt"a a,•n'�+o:a,,ie vet�n'y ou'r"W'till""an"erI consent,
<br /> ..... ......
<br /> t a.lrin MH be i H'aaa'able'drrn a aiternaa¢tl'are for emaa",:a r eIlaalrgn:+,a °n, IhraH a, upon s.raue5t.
<br /> ........ ......... .....
<br /> An equal g31tunity employer
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