the peace in and for the said county [or borough, &c.], as well upon the oath of the said A. B. as otherwise, that the said sum of hath been duly demanded in writing by him from the said C. D., and that the said hath refused to pay the same for the space of fourteen days after such demand made, and doth refuse to pay the same: And whereas the said C. D. hath been duly summoned to appear before me to show cause why the said sum should not be paid by him, and not having shown to me any sufficient cause why the same should not be paid. These are therefore, in her majesty's name, to command you to levy the said sum of and also the sum of

the costs of proceeding to obtain this warrant, by distress and sale of the goods and chattels of the said C. D., and your reasonable charges of taking, keeping and selling the said distress, rendering to him the overplus (if any), on demand; and if sufficient distress cannot be found of the goods and chattels of the said C. D., that then you certify the same to me, together with this warrant, to the end that such further proceedings may be had therein as to the law doth appertain.

Given under my hand and seal, the

day of

(Signed)

E. F. (L.S.)

in the year of our Lord

County of

No. XXXV. Form of Conviction.

[or Borough, &c.] to wit.

before me [or us]

-, one [or two] of her majesty's justices of the peace in and for the county [or borough, &c.] of [here describe the offence generally, and the time and place when and where committed in the words of this act, or as near thereunto as may be], contrary to the Public Health Act, 1848; and I [or we] do adjudge that the said A. B. hath forfeited for his said offence the sum of [amount of penalty adjudged], and that he do pay to C. D. the further as and for his costs in this behalf.

sum of

Given under my hand and seal [or our hands and seals], the day and year first above written.

No. XXXVI. Form of Order to permit
Execution of Works by Owners.

County of
[or Borough, &c.]
to wit.

WHEREAS Complaint hath been made to me, E. F., esquire, one of her majesty's justices of the peace in and for the county [or borough, &c.] by A. B., owner, within the meaning of the Public Health Act, 1848, of certain premises, to wit, a house [as the case may

be] situate in

street [as the case may be], in the parish of in the said county [or borough, &c.], that C. D., the occupier of the said premises, doth prevent the said A. B. from obeying and carrying into effect the provisions of the said act in this, to wit, that he the said C. D. doth prevent the said A. B. from [here describe the works generally, according to circumstances, for instance, thus: constructing and laying down, in connection with the said house, a covered drain, so as to communicate with a [sewer or drain] of [insert description of sanitary authority] [or a sewer, &c. which [insert description of sanitary authority] are entitled to use, as the case may require], such sewer being within 100 feet of the said house] and whereas the said C. D., having been duly summoned to answer the said complaint, and not having shown sufficient cause against the same, and it appearing to me that the said works are necessary for the purpose of enabling the said A. B. to obey and carry into effect the provisions of the said act: I do hereby order that the said C. D. do permit the said A. B. to execute the same in the manner required by the said acts.

Given under my hand and seal, this in the year of our Lord 18-.

day of

No. XXXVII. Grant of Rent-charge.

By virtue of the Public Health Act, 1848, the [insert description of sanitary authority] do hereby

declare and absolutely order that the inheritance of the [dwelling-house, shop, lands and premises, as the case may be], situate in street, in the parish

of

within the said district, and now in the occupation of, shall be absolutely charged with the sum of pounds, paid by - of for the improvement by drainage and water supply [as the case may be] of the same dwelling-house, shop, lands and premises [as the case may be], together with interest for the same from the date hereof at - pounds per centum per annum, until full payment thereof, and also all costs incurred by the said his executors, administrators or assigns, under this security, shall be fully paid and satisfied: And we hereby further declare that the said principal and interest moneys shall be paid and payable by the owner or occupier of the said premises to the said his executors, administrators and assigns, in manner following: (that is to say,) the interest on such principal sum of pounds, or on so much

thereof as shall from time to time remain due and payable under this order, shall be paid and payable by equal half-yearly payments, whilst payable, on the and the

day of

day of

in

every year, the first payment thereof to be made on

next, and such principal

pounds shall be paid and payable

the

day of

sum of

by day of

equal annual instalments on the

in each of the next succeeding

years towards the discharge of the same principal sum, until the whole shall be fully satisfied and discharged.

No. XXXVIII. Form of Notice requiring Owner to do Works.

[Insert description of sanitary authority.] The

of

To

in the county of

the owner of certain premises fronting, adjoining or abutting upon a certain street called within the said [borough or district, as the case may be].

Whereas the said street is not sewered, levelled, paved, flagged and channelled to the satisfaction of the above-named sanitary authority; and whereas your said premises front, adjoin or abut on certain parts of the said street which require to be sewered, levelled, paved, flagged and channelled: Now, therefore, the said [insert description of sanitary authority] hereby give you notice (in pursuance of the statute in that case made and provided) to sewer, level, pave, flag and channel the same within the space of [state the time] from the date hereof, in manner following: (that is to say,) the sewers to be laid or made [here describe the mode to be adopted and the material to be used], of the sizes and forms, and at the rate or rates of inclination shown on the plans and sections of the works as prepared by the surveyor of the sanitary authority.

Each gully for surface draining, and its connection with the sewer, to be placed as shown on the said plans, and to be constructed of the forms, materials and dimensions as shown on the said plans.

A foundation for the carriageway and footway in the said street to be formed in the following manner