Application for property owner applying dust suppression to town roads

Permit Request for the Application of Dust Suppression by Home Owner

Dust Suppression may be applied by a Home Owner on a Township Road. Conditions of this application are as follows:
The Dust Suppression material and labor are at the Property Owner’s expense.
The maximum length of an application for an individual property is up to 1/8^thof a mile.
The application must not extend beyond the frontage of that property owner parcel/s.

The White Oak Township Board or designee may approve the permit for dust suppression and an approved permit shall be recorded at the next board meeting.

The application of dust suppression material must not exceed the Minnesota DOT Guidelines.

Property Owner(s) _____________________________________________________________________ Local Address(s) _______________________________________________________________________

Contact ___________________________ phone _______________e-mail________________________

List any adjacent owners and property addresses which will be included if more than 1 property is to be treated.

Owner______________________________ Address_________________________________________

We (I) the undersigned make application to apply dust suppressant to the township road section within my/our property borders.

The product to be used is (name)_______________________________________________________

and is sold by_______________________________________ (A Material Safety Data sheet or MN DOT requirements would be helpful in expediating approval.)

Applicant________________________________________ Date_______________________________

Approved/Denied by __________________________________ Date_____________________________