Fillable Form 7: Schedule 2: Sewage System Installer Information (City of London, Ontario)

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Form 7: Schedule 2: Sewage System Installer Information (City of London, Ontario)

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Country of origin: CANADA
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PO Box 5035
7
th
Floor, City Hall
London ON N6A 4L9
BCIN: 18458
Schedule 2: Sewage System Installer Information
A. Project Information
Building number, street name Unit number Lot/con.
Municipality Postal code Plan number/ other description
B. Sewage system installer
Is the installer of the sewage system engaged in the business of constructing on-site, installing, repairing, servicing, cleaning or
emptying sewage systems, in accordance with Building Code Article 3.3.1.1, Division C?
Yes (Continue to Section C) No (Continue to Section E) Installer unknown at time of
application (Continue to Section E)
C. Registered installer information (where answer to B is “Yes”)
Name BCIN
Street address Unit number Lot/con.
Municipality Postal code Province E-mail
Telephone number
( )
Fax
( )
Cell number
( )
D. Qualified supervisor information (where answer to section B is “Yes”)
Name of qualified supervisor(s)
Building Code Identification Number (BCIN)
E. Declaration of Applicant:
I _______________________________________________________________________________________declare that:
(print name)
I am the applicant for the permit to construct the sewage system. If the installer is unknown at time of application, I shall
submit a new Schedule 2 prior to construction when the installer is known;
OR
I am the holder of the permit to construct the sewage system, and am submitting a new Schedule 2 now that the installer is
known.
I certify that:
1. The information contained in this schedule is true to the best of my knowledge.
2. If the owner is a corporation or partnership, I have authority to bind the corporation or partnership.
___________________________________ _________________________________________________________________
Date Signature of applicant
Form no 0842 (rev.2011.13) www.london.ca
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Form 7: Schedule 2: Sewage System Installer Information (City of London, Ontario)

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Completed 8 April 2022

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