Septic Hauler Authorization Application

Type(s)

Building & Development

Public Works

Applicant Information

Organization Name

Business License Number

Contact Name

Phone

Address

City/Town

Province/State

Postal/ZIP Code

Country

Truck Information

Truck

Truck
Year Make Model License Plate Number Load capacity in cubic meters Does this truck have a meter? Yes No Do you currently have a Shelley Lagoon fob associated with this truck? Yes No

Bylaws

Agreement

I have read the Sanitary Sewer Use Bylaw and understand that I must report my manifest monthly.
I understand that I can be fined up to $5000.00 for illegal reporting and dumping.
I understand that the personal information on this form is collected by the City of Prince George for the purposes of processing this application, under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act.

If you have any questions about the collection of information, please contact the City of Prince

George at 1100 Patricia Boulevard, Prince George, BC, or by telephone 250-561-7600.

Learn more information about the collection of personal information under the Freedom of Information and Protection of Privacy Act.

I agree to all of the terms stated in this application