Courtenay : Règlement no 1926, art. 10 — $100.00 SCHEDULE "C" APPENDIX II DATE PERMIT NO

Purpose of Excavation and Construction I/We hereby agree to be bound by the provisions of City of Courtenay Traffic Regulation Bylaw and amendments, if any, specifications, and regulations of the City governing excavations in or under municipal streets and to such special conditions, restrictions, and regulations as may be imposed by the Superintendent of Public Works See conditions and regulations attached hereto Applicant's Signature PERMIT FEE:

• $100.00 SCHEDULE "C" APPENDIX II DATE PERMIT NO.
• CITY OF COURTENAY PUBLIC WORKS DIVISION STREET EXCAVATION AND CONSTRUCTION APPLICATION FOR DEPARTMENT USE ONLY