APPLICATION FOR SPECIAL pera aed)

Pursuant to Section 4 of fine i rf Aj C

“CTY OF PORT COQUITLAM FIRE PREVENTION BY-LAW, _1968, fo.

site or sites thereon:
(a) Legal Description:
(b) Civic Address: 3/67 STRAT FORD
(c) Exact Location of Burning Site or Sites:

Reech Val : BACK YARD

2. (a) Name of Registered Owner: ACI PEA U
(b) Registered Owner's Consent to this Application:

Signature of Registered Owner Aa fio
{Position with Limited Company) C307; Le 4 souls (4£ applicable)

SENT Bn ae AN me End ct be AIR eer, Etat

3. The days and the times of those days upon which in is proposed “0
have the fire burning:

cheer % Le ate fling sore Lana

zt ad &. eaten 4 La*r, f

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

TYPE AMOUNT

og 7

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

Aa tht Pacer,

6. Whether or not some special neshoy of combustion is proposed to
promote a "smokeless" fire: .

| (a) We do not propose to use any special method of combustion [ef
(b) The following special method of combustion is Proposed:

PROCEDURE OV
1, Complete and submit both copies to Siaupeope’ot Aoplicant

Fine Department,
2. Fane Department reports on reverse ; Oe ite fees
Side and fonvards to City Clerk. Company Name

- City Clerk places on Agenda for , 46 Sas, f.
Counci£ meeting, § are £ la

941-5 7 3U
Telephone

Date of Application