Form ID

Publication date

Location of premises

Certificate

Earthworks and Roadworks

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Richard Schultz
Address of Owner
R.R. #2, Desboro, ON N0H 1K0
Name of Contractor
Subterra Inc.
Address of Contractor
934 Guelph St., Kitchener, ON N2H 5Z6.
Name of Certifier
Totten Sims Hubicki Associates
Address of Certifier
72 Victoria Street South, Suite 202, Kitchener, ON N2G 4Y9

Identification of Premises

Part of Park Lot 1, Registered Plan 276