Permit to Dispose of Material

1. Applicant Applicant name is required.
2. Mailing Address A mailing address is required.
3. Phone A phone number is required.
4. Purpose A purpose needs to be stated.

Fill/Demolition Materials

1. Concrete (with rebar) Concrete (without rebar) Earth Earth with wood Snow Gravel Soil Sand Stones Mixed concrete Steel Bricks Tiles/Ceramic Please make at least one material selection.
2. Other      Other Details

1. Total Quantity Provide details on the total quantity of material.
2. Land Location materials are to be removed from Include details of where the material will be removed from.
3. Land Location materials are to be removed to Include details of where the material will be removed to.
4. Start Date You must include a start date.
5. End Date You must include an end date.

1. This permit is subject to compliance with all other regulatory requirements. No person shall obstruct the Administrator or an Inspector who is carrying out an inspection. Any person who contravenes any provision of this permit, Bylaw No. 4 of 2010 and Bylaw No. 8 of 2010 is guilty of an offence and liable to the penalty as set forth in the General Penalty Bylaw of the R.M. of Prince Albert No. 461.
   I certify that the information is correct, complete and that I will abide by the Bylaws and the conditions of the approval. You must certify that the information is correct and agree to abide by the Bylaws and the conditions of approval.