APPLICATION FOR SPECIAL WRITTEN PERMIT

Pursuant to Section 4 of C | J ie
“CITY OF PORT COQUITLAM FIRE PREVENTION B AWS 1968, S 90 d
OCT. 31 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: . Lo . - oO
a) Legal Description: 7-777 ep acne LYE Ve ACE Y,
(a) Leg, P A ;
(b) Civic Address: Px As A 6 ta

(c) Exact Location of Burning Site or Sites: . .
Copwaas 7  PRoPERTY

Cilmi n tf f4nt

/. ,
2. (a) Name of Registered Owner: : Loy 2 Naw eS:
(b) Registered Owner's Consent to this Application: :

Signature of Registered Owner f
(Position with Limited Company) a

(if. applicable}

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

Ane é SUPT es Pa
fh) Ru kiwi nw a.

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

TYPE AMOUNT

UNWER RRu se RPRR iw
m- SA ODkIWES 3 7TRutlK AALS

Koo Ken  NMoeive LVR WH
7 ; 7. ;

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

CAPTTFERBRIALYRR CW SIF

6. Whether or not some special method of combus
promote a "smokeless" fire: .
| (a) We do not: propuse to use any special method of combustion ~

tion is proposed to

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

“yd,
PROCEDURE oo C t CAN Cpl nm
1. Complete and submit both copies to . Signature of Applicant
Fixe Departnent. <
2. Fire Department reports on reverse ;
Company’ Name

side and fonvards to City CLerk, . , . ;
3. City Clerk places on Agenda for (Pe S tk PES. ‘
Counci£ meeting. ,

Address

; _€50  PorTFR STe
(OeT kes a 2 WA Telephone PIE - “G12

Date of Application