APPLICATION FOR SPECIAL written (phen
Pursuant to Section 4 of they U

"CITY OF PORT COQUITLAM FIRE PREVENTION BY-LAW, 1968, No. 962".

- NOV 28 1977"
1. The legal description and civic address of the Property upon which
it is proposed to set the fire and the exact location-of the burning
site or sites thereon: . :

(a) Legal Description: Lets SSS S% —~S7-6%470 NE Ly SFE Te. Ho flav SVE

(b) Civic Address: e-922-9 30 - PES-97S1 Coruwale Place.

(c) Exact Location of Burning Site or Sites:
SENTHKR. oF Lots

2. (a) Name of Registered Owner: _AIERID lars PevrLopamanTs Coe: 470)
(b) Registered Owner's Consent to this Application:
Signature of Registered Owner LXDE >"

(Position with Limited Company) Liiatetln : (1£ applicable)

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

AfborxwiriTieg 7 evetienwrd Days ~~ Exook Mou.
* c
Fe fCaew Decen-Bre — Déys aovey
7 7 7

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

TYPE AMOUNT

AWD heae vig TRE Lynn es Aeon 2 BOO Cw. yos
Slon—ps wert ;

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

Bvuiposzee: df BakWoe — Ta Conta A Swr0eWvae
Brent mg ewidtlTere Cor Spat Fuice's

6. Whether or not some special method of combustion is proposed to
promote a "smokeless" fire:

(a} We do not propose to use any special method of combustion [4]
(b) The following special method of combustion is proposed:

——*

PROCEDURE LA
I. Complete and submit both copies to Signature of Applicant
Fine Department. .
2, Fine Department reports on reverse LCR P19! DEE COLTD,
side and forwards to City CLerk, Company Name
3. City CLork places on Agenda for: #4 sot ec. AusTiw AVE Cog.
Comccl meeting. : , Address ”
P2P ES 33

fad we Telephone

Date of Application