SCHEDULE D - TOWN OF VIEW ROYAL DECLARATION OF SOIL REMOVAL OR DEPOSIT QUANTITIES

TOWN OF VIEW ROYAL DECLARATION OF SOIL REMOVAL OR DEPOSIT QUANTITIES

Information

Soil Removal or Deposit Permit No. _______________________ Date of Issue _______________________

Land Identification Information

Legal description __________________________________________________________________________________

Municipal address __________________________________________________________________________________

Land Ownership

Registered owner __________________________________________________________________________________

Address of owner __________________________________________________________________________________

Lease holder __________________________________________________________________________________

Address of lease holder __________________________________________________________________________________

I hereby declare that during the period __________ to __________ inclusive, the volume of Soil removed was __________ cubic metres and that the volume of Soil deposited was __________ cubic metres.

I declare that I have personal knowledge of these matters and I make solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.

Signed: ____________________________________________ Date: __________________________________

________________________________________________________ (address)

________________________________________________________ (position title, owner, lessee or signing officer of limited company)

SWORN BEFORE ME at the City of __________ ) __________, in the Province of British ) Columbia, this _____ day of __________, 20____. ) ) )

__________________________________________ __________________________________________ A Commissioner for Taking Affidavits Name in the Province of British Columbia