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PERV,

2
I, the applicant for the soil removal permit. for removal of soil from. tha
above address, acknowledge that I have read this letter and agrea 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 profes ational

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

Witness's Signature Signature of Applicant for
Permit

Print

Name

The Corporate Seal of

(Corporate was hereto affixed in the
presence of:

Authorized Signing Officer

Authorized Signing Officer