APPLICATION FOR SPECIAL WRITTENSPRRNTR
M

‘Pursuant to Section 4 of the

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

MAY 17 dors
1. The legal description and civic address of the property upon which
it is proposed to set the fire and the exact lncation of the burnin;
site or sites thereon:

(a) Legal Description: R « ! OQ Nob |GH10

(b) Civic Address: |$il Wesrmin sTéR Avedve

(c) Exact Location of Burning Site or Sites: (>, IR OWI fi rime
ADDRESS, TRYING Oo Clea OP Mae lar.

(a) Name of Registered Owner: \ eon ARD GC.
(b) Registered Owner's Consent to this Applica
: Signature of Registered Owner

7) i”
.(Position with Limited Company) rn) Q (if applicable)

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

SatvoRDaAY May 20 THRa ven To THe
Baosnpan May 30 197. Time DOD
Re 12 Soon To 4PM GaAcH Way.

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

‘TYPE AMOUNT
R ors : CleaRin c. .QUR
Lor vane

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

Hose 15 ConnecTeD AY ALL T cA
AND We ARES BANNING ON RARE Secu.
Newly Corrivaren GRoond: BRoueN ft 3_GCRasSs -

6. Whether or not some special neshog of 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 f— .
oo Aan ea

Complete and submit both copies ta Sighature of Applicant
Fine Department,

Fine Department reports on reverse N | A

side and forvards to City Clerk. Company Name .
City Clerk places on Agenda {or SIA Wesrm mi. ft 1 VENCE
Counci£ meeting, Address ae
42-159, On

521 19tt hLoctme x)

Telephone INNES occ HoetiraL

May IN wrt

Date OF Application