APPLICATION FOR SPECIAL WRITTEN PERMIT CO

Pursuant to Section 4 of the

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

one!

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:

(a) Legal Description: <0 Wf Bunce GEP! Dir Lo 2850 394/ find YSIS .
(b) Civic Address: £092 ConNAvuget— OR
(c) Exact Location of Burning Site or Sites: CENTRE Of Korn

Name of Registered Ower: Sfow/ ¢ AE Mase Sor}
Registered Owner's Consent to this Application:

Signature of Registered Owner Leiner tr Dyas
wo” a i=
(Position with Limited Company) (if applicable)

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

MAR CH fe - /0O th S97 eerween! F-00 pit AN2 S100 py
[Za DLP ES et T 1 UF: og et LE ULtd QI hy

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

TIPE AMOUNT
SRS WE Goearzee DEGRese . APPRRaAY 3 Cotas

5. The methods proposed to control or abate any possible spread of fire
or other. danger or nuisance: .
SMALE FIRE AND. CON SrAN ASVLVRELLANEE

6. Whether or net some special method of combustion is proposed to
promote a "smokeless" fire:

‘{a} We do not propuse to use any special method of combustion [-
(b) The following special method of combustion is proposed:

.

+

R URE .
PROCEDURE ; ; LO rented,
1. Complete and submit both copies to Signature of Applicant

Fine Department.
| 2. Fane Department reports on reverse Brow! & Hettistlord

Side and forwards to City CLerk, Company Name.

| 3+ City Clerk places on Agenda gor su kes Ave WA. Van couvnite
Council meeting. Address

P29- S752»
Telephone

Nek
Ce eal 76

Date of Application