APPLICATION FOR SPECIAL WRITTEN SRRMPR,
Pursuant to Section 4 of ue, U U N C
"CITY OF PORT COQUITLAM FIRE PREVENTION BY-LAW, 1968, No. 902"!

JAN 2 3 1978

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

gite or sites thereon:

LLU
(a) Legal Description: ~ 07 SSK OF OR <SS BATH 7 KFIEF
(b) Civic Address: “OPS TOM SEL LT
(c) Exace Location of Burning Site or Sites: CA OK 407"

Name of Registered Owner: LNELLOR MDL LED
Registered Owner's Consent to this Set.

Signature of Registered Owner “77777 5 ae

(Position with Limited Company)

(LE applicable)

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

SZ. DIOL AE KI SUN .§ TRY RG
LEZVMEL! O00 Ati AVVO FOO IP?

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

TYPE AMOUNT.

ZEEE LCR Her etna tan Lore Kerrie)
LIVES Cw SLOLEK THELESS Fob OF
LLL CSS Kee SEES C Oat CLEALMMO
FOLIC BSN OPIT AS,
5. The methods proposed to control or abate any possible spread of fire
or other danger or nuisance:

LYOS LE LP LOOL_ POL SL RE KF LOU, ALR EFBRSO
LEEDS FE sO Ae FIDE LEPC PI LILR: C06. FON

LLLE.

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 Kk]

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

PROCEDURE Ped KEL.

1. Comp£ete and submit both copies to Signature of Applicant
Fine Department,

2. Fire Department reports. on reverse
side and forwards to City Clerk. Company Name
-

3. City CLerk places on Agenda for PREL L RO MRE.
Councté meeting. Address
FISK ZH E

Telephone

LILLE.
ate of Appifcation