ee,

APPLICATION FOR SPECIAL WRITTEN PERMIT mss ( OU
Pursuant to Section 4 of the
HAY 2

"CITY OF PORT COQUITLAM FIRE PREVENTION BY-LAW, 1968, No.

anaes
1. The legal description and civic address of the property upon which
it 1s proposed to set the fire and the exact location of the burning
site or sites thereon:
(a) Legal Description: Lot S Blk 6B6NRIE Plan 11595

(b) Civic Addruss: 1305 Dominion Avenue Port Coquitlam, Bg.

(c) Exact Location of Burning Site or Sites:
Open back field portion of above address

(a) Name of Registered Owner: _Thomas  Rudnisky
(b) Registered Owner's Consent to this Application:
Signature of Registered Owner Sha.) NS. Qe xe
(Position with Limited Company) N/A (if applicable)

3. The days and the times of those days upon which it is proposed to
have the fire burning:

Weekends only - daylight hours

4. The type or types of material proposed to be burnt and a reasonably
accurate estimate of the amount of such material:

TYPE AMOUNT

Le prysh & Stumps from back of the
property thet were piled 1 yeer apo several piles
2. Some burnable material from demolition only whet cendt

oF old house of the above property be salvaged for
reuse.

5. The methods proposed to control or abate any possible spread of fire
or other danger or nuisance:

Wilk have a Bulldozer and Bachoe on standby with
operators ir case fire might start to spread - Spread
ing will be unlikely 6s burning will be done in clesred
area,

6. Whether or not some special method of combustion is proposed to
promote a “smokeless” fire:
(2) We do not prcopose to use any special method of combustion |

(b) The following special method of combustion is proposed:

PROCEDURE QC:
PROCEDURE Ne wo we

Complete and submit both copies to Signature of Applicant
Fine Department.

2. Fine Department rcports on reverse Homeowner
side and fomards to City Clerk. Company Name

3. City Clerk places on Agenda fox 1505 Dominion Avenue
Council meeting. Address port Coquitiem, B.C

SAS NRA
Telephone

pODoe ee AAR

Date of Application