CITY OF PORT COQUITLAM
SUBDIVISION CONTROL
HYDRANT USE PERMIT

Applicant's Name:
Address:

Telephone:

PERMISSION {S HEREBY GRANTED TO THE ABOVE TO USE THE HYDRANT LOCATED AT:

PURPOSE:

CONDITIONS OF USE:

1. City will supply and install a backflow prevention device with valves
opened by the City. Independent Hydrant Port NOT to be used by the
Permit Holder.

Valid for use ~ Monday to Friday, between the hours of 8:00 A.M. and 3:30
P.M.

For usage not in the above specified hours or days, Permit Fee is $175.00
per day.

I HEREBY AGREE TO ALI THE TERMS OF THE HIGHWAY AND WATER BY-LAWS AS THEY
PERTAIN TO THIS PERMIT AND GUARANTEE THE FULFILLMENT OF TERMS SET OUT THEREIN
WITHIN THE TIME SPECIFIED IN THIS PERMIT.

This Permit Shall Commence On:
And Shall Expire On:
Permit Extension Date:

Applicant's Signature

Permit Issued By The City Engineer

City Engineer
DATE:

FLAT FEES $ 100.00/per day x

OVERTIME RATE $ 175.00/per day x

TOTALS

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