THE CORPORATION OF THE CITY OF PORT COQUITLAM
“SOIL REMOVAL REGULATION BYLAW NO. 2827"

SCHEDULE “D"
DECLARATION

PERMIT NO. EXPIRY DATE

PERMIT FEE PAID based on cubic metres.

AMOUNT ENCLOSED (3.10 per cubic metre in excess of quantity

specified in permit)

CANADA ) IN THE MATTER OF THE CITY OF PORT
PROVINCE OF BRITISH COQUITLAM SOIL REMOVAL BYLAW
COLUMBIA NO. 2827, 1993, AND

PERMIT NO. '

(permit holder)

(address)

IN THE PROVINCE OF BRITISH COLUMBIA DO SOLEMNLY DECLARE THAT:

Iam the

(Owner, Lessee, Signing Officer of Limited Company)
of

(address)
That [ have personal knowledge hereinarter deposed.
I hereby declare that during the period:

to

the volume of soil removed from the lands described on Permit No.

issued to:

on the day of

in the year cubic metres.

TER
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