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i <br />J,� I�r � <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 />�.-/._ � <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 />Business Name � L'� I v� �� T/ Telephone No. <br />Business Address <br />Description of Activity Requiring Permit <br />��%- 7�C� � <br />��--LC� i:��Fz'/1/ �JC� �✓ �l � l� QC�-1` �' / <br />L� (� ��-rv l�- i N����v c� �/�'�%�' ! <br />Remarks <br />ApP <br />Inspeciion maae ny: <br />� <br />Signature <br />U �' <br />Date ���4�� G/ <br />Fire Marshal <br />Date <br />\1Victoria\CommDev\Permits\Permit Applications�Buming_Permit_doc <br />