APPLICATION FOR SPECTAL WRITTEN PERMIT.

Pursuant to Section 4 of the

: "CITY OF PORT COQUITLAM FIRE PREVENT}ON f\ Al Lob! LO ab)
Le a

1. The legal description and civic address of the pro  ofhB, 2} ol8 4
it is proposed to set the fire and the exact location of the burning
site or sites thereon: asp Geek. TP ~2

(a) Legal Description: Lyamw,$” ZL, rp SLye VP SH
fb) Civic Address: Ss 7 > AD KAA,
(c) Exact "Gr cw oF} Burning Site a

West \Party

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( 2. (a) Name of Registered Owner: (f _A-o43, WLyror ol f
UA a :

(b) Registered Owner's Consent to this Application: : ;
Signature of Registered Owner AA 2 prop Mi tiegl : , 4
ae .

(Position with Limited Company) (if applicable)

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

snp tin Down ee al 2 Ci afeg yf ;
i fitch ud L, VA LA fot. Aen. 7 :

: 4. The type or types of material proposed to be burnt and a reasonably :
accurate estimate of the amount of such material: 1

AMOUNT

: . bide Bagh ed

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a 7

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

Re fo ee

; 6. Whether or not some special method 6f combustion is proposed to
promote a “smokeless” fire:

(a) We do not propose to use any special method of combustion

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

PROCEDURE A 20-48. Woon P yi

4. Complete and submit both copies to Signature of Appiicant”
Fine Department.

2. Fine Department reports on Acverse

bide and fomvards to City Clerk. Company Name j
. City CLerk places on Agenda for 67 Pb rwrrsce Oard
Comcil meeting. Address
Put VILLA,
Telephone

wek /t ft 7

Date of Application