Q-2, r. 21 - Regulation respecting waterworks and sewer services

Schedule Disposition versions

2012-09-01

FORM 10

(s. 50)

GOUVERNEMENT DU QUÉBEC

MINISTÈRE DU DÉVELOPPEMENT DURABLE, DE L’ENVIRONNEMENT ET DES PARCS

APPLICATION FOR TRANSFER OF A WATERWORKS OR SEWER PERMIT

The undersigned applicant applies to the Minister of Sustainable Development, Environment and Parks for the transfer to him of the waterworks or sewer permit hereunder described:

1- Name and address of applicant:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

2- Nature of applicant partnership, association, legal person or company: _______________________________________________________________________

3- Date and place of registration or constitution of applicant:

____________________________________________________________________________

4- Name and address of person responsible for the administration:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

5- Name and address of person responsible for the operation:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

6- Name of municipality (ies) served by the waterworks or sewer system (indicate the service) and their designation (city, town, village, parish, township, etc.)

 _______________________________________________________________________________
|                           |                   |                               |
|        Municipality       |   Designation     |     Number of subscribers     |
|___________________________|___________________|_______________________________|
|                           |                   |                               |
|___________________________|___________________|_______________________________|
|                           |                   |                               |
|___________________________|___________________|_______________________________|
|                           |                   |                               |
|___________________________|___________________|_______________________________|
                               

7- Name and address of current owner of the waterworks or sewer service:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

8- Permit number: ________________________________________________________________

9- (If the transaction does not affect the whole service, indicate and give particulars on a separate sheet).

10- Sale price of the service: ________________________________________________________

11- ANNEX A COPY OF THE SALES CONTRACT.

Date: this ____________________ 20_____

______________________________________

Signature of applicant

Permit holder’s declaration

I, the undersigned, apply to the Minister of Sustainable Development, Environment and Parks for the transfer of my waterworks or sewer permit numbered _________________________ to:

Name: _______________________________________________________________________

Address: ________________________________________________________________________

Date: this _____________________ 20_____

______________________________________

Current permit holder’s signature

______________________________________

Name of waterworks or sewer service

R.R.Q., 1981, c. Q-2, r. 7, Form 10.