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�t <br />� <br />� � �i� w ,� <br />. � <br />APPLICATION FOR BURNING PERMIT <br />Receipt No. <br />Application No. <br />Date Permit Expires: <br />Location: <br />FIRE MARSHAL, City of Roseville <br />Permit No. <br />Date Issued: <br />Fee Paid: <br />�-, ,�. J � �. <br />The undersigned hereby makes application for a permit as indicated and agrees to comply <br />with the City ordinances and rulings of the Fire Prevention Office, and hereby declares that <br />all the facts and representations stated in this application are true and correct. <br />� <br />Business Name _ _ � __ �� L�.� <br />Business Address <br />Telephone No. � �R�f 7`/ <br />loJl� �{6z`�-'7�=0 �' <br />Description of Activity Requiring Permit 17 � L-i-O �,f�(�`(� �fi �j D�F' ��� <br />a�r� �i <br />,�/�G� � �' �, a �v `� / `� l2- �� �� a N <br />N� �� 1 <br />Remarks � v� R-� J�L La L.trf � N �UIZ O f/I�/� � 4 � f� S. <br />Iii/L� �' �(/G �h'�(i/� Y � o ! T �7- p 06' S �¢�A �>4L �� <br />O � FO <br />Signature <br />Fire Marshal <br />Date <br />Q:�Permits�Permit Applications�Burnin�Permit.doc <br />Date -S F��' � 7 �' <br />��. <br />