19. If the volume of soil to be deposited exceeds 200 cubic metres there is attached a survey
plan prepared by a British Columbia Land Surveyor of the property on which the soul is to
be deposited showing a one metre contour interval or a grid of spot elevations no more than
5 metres apart on the parcel and indicating all the information required by Section 11 of
"Soil Deposit Regulation Byiaw, 1993, No. 2826".

. Where the amount of the soil to be deposited exceeds 200 cubic metres and section 12 of
"Soil Deposit Regulation Bylaw, 1993, No. 2826" applies, the required plans, specifications
and letter of assurances and undertaking all duly signed and sealed are attached to this
application.

I declare that the above information is correct, that it is my intention to deposit soil upon the
property in accordance with the attached plans and specifications and information, that I am
aware of the provisions of the City of Port Coquitlam "Soil Deposit Regulation Bylaw, 1993,
No. 2826" and that I will abide by all applicable provisions of the bylaw and such terms and
conditions as form part of any Soil Deposit Permit issued pursuant to this Application.

Date

Signature of Applicant:

Applicant’s Name Printed:

Received from:

(Applicant’s mame)

this day of ,19 the sum of $

Deposit Permit Application Fee.

Receipt No.

City Engineer