APPLICATION FOR SPECIAL WRITTEN PERMIT
Pursuant to Section 4 of the

"CITY OF PORT COQUITLAM FIRE PREVENTION BY-LAW, 1968, No. 902"

ATR

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 iffgy
site or sites thereon: ( [

(a) Legal Description:
(b) Civic Address: % S609 7 CA FEB-9 1976
(c) Exact Location of Burning Site or Sites:

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(a) Name of Registered Owner: VERA Vala RUSE

(b) Registered Owner's Consent to this Appl fation: ys ,
Signature of Registered Owner LAL Ai gy rats 4 ‘

(Position with Limited Company)

ra (1£ appl:cable)

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

Duwi nwt WEEK DAYS

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

TYPE AMOUNT

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

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6. Whether or not some special method of combustion is proposed to
promote a "smokeless" fire:
‘(a) We do not propuse to use any special method of combustion [J
(b) The following special method of combustion is proposed:

Con o Pay Kiwoli we pase

PROCEDURE
« Complete and submit both copies to Signature of Applicant

Fé .
ane Department LAs, ae OY a nety ;

Fine Department reports on reverse -
bide and fonvands to City Clerk, Company Name ¢

City Clerk p£aces on Agenda for
Counci£ meeting. Address e y
AA L6 pL Te, /.

Telephone

FEBS 14976. GY 2-2PE

Date of Application