COMMON APPLICATION FORM

I, ~_/OHe/ Bowles _ certify that all information contained

(PLEASE PRINT}

herein is true to the best of my knowledge.

Cg an Mov 23/92.

Applicany’or Representative's Signature Date Signed

A. APPLICANT

Neme

Hanes Towne (Co. bLTp .

Addresa

9990. Aaque ST,
Postel Code
Pe pt CoeutTiam ,&.C: V2 0. 3VE

Contact Telephone

Tou Bawlés S/-32¢3

Occupstlon Company Incorporation Number

CY¥es canadian Citizen MYes president in B.C. for 2 Years O Yes

Age 19 Yaars of ov
9 oF over No C1No ONo

B. APPLICANT'S REPRESENTATIVE:

Name

Same as Above:

Address

Postal Code

Contact Telephone

C. RIPARIAN OWNER

Dip ~ CH anbet. LEASE -

Addraca

Postal Code

Contact Telephone

D. SURVEYOR

Name

Contact Telephone

E. PROPOSED ACTIVITY (if not lease application)

75. AELIALE OLD Ard MUSSIN/E ALines WS De? MATER

Powxiow) oe ke feamit Area with SWeLe STEEC OPE

p ces:
F. PROJECT LOCATION

Municipsl Address

Legal Description of tpt WATCR Lor
Pezmit = 57.557 Acaée Poation Feewnue Hagons oF

E.$.19, 20%3¢, BGM, RIE + Poetion) Of Lov 467, FRO 1 Mud

MNidsee GRovwnd

Habitat Classification Map No. ___. _ Habitat Classification

Paga 2.