I, the applicant for the soil deposit permit for deposit of soil at the above address, acknowledge
that I have read this letter and agree with its contents. I have also reviewed the plans,
specifications and supporting documents attached to this letter and agree with them. I advise
you that I have given:

name of registered professional

the authority to conduct testing, field review and to supervise the deposit of the soil including
the authority te stop the depesit of soil, remove soil or redirect it as set out in this letter. I
acknowledge and understand that all authority and permission to deposit soil under any permit
issued to me pursuant to any application will automatically cease and be suspended if the
registered professional’s services are terminated or limited and will not be re-instated until such
time as another registered professional submits to you a signed and completed letter in this form.

Witness’s Signature Signature of Applicant for
Permit

Print: Print:

Address

The Corporate Seal of

(Corporate Seal) was hereto affixed in the
presence of:

Authorized Signing Officer

Authorized Signing Officer