THE CORPORATION OF THE CITY OF PORT COQUITLAM

"SOIL DEPOSIT REGULATION
BYLAW NO. 2826"

SCHEDULE "A”
Application for Soil B it Permit N

of
(full name) (address)

hereby apply for a permit to deposit soil upon the

(telephone)
following property:
Address

Legal Description

The origin and source of the soil to be deposited is:

Address

Legal Description

The registered owner of the property upon which the soil is to be deposited is

of
(full name) (address)

(telephone)

If the applicant is not the registered owner of the property on which the soil is to be
deposited then the registered owner by signing here authorizes the applicant to make this
application. .

Signature of Owner

The soil is being deposited for the following purpose:

The ground area upon which the soil is to be deposited is _ hectares.

The total volume of soil to be deposited is cubic metres.