Form ID

Publication date

Location of premises

Certificate

Installation of Approx. 200m of Watermain, Sanitary & Storm System Road Works

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Jack Michielsen Builder Inc.
Address of Owner
125 Park Street, Parkhill Ontario N0M 2K0
Name of Contractor
Van Bree Drainage & Bulldozing Limited.
Address of Contractor
7074 Nauvoo Road, R.R. #6, Forest, Ont. N0N 1J0.
Name of Certifier
Duwayne Hay
Address of Certifier
14 Abacus Road, Brampton, Ontario L6T 5B7

Identification of Premises

Plan No. 38T-012006