[here describe the mode to be adopted and the material to be used], and the said carriageway and footway to be paved [here describe the mode to be adopted and the material to be used].

The channel stones to be [here describe the mode to be adopted and the material to be used]. The curb or side stones to be [here describe the mode to be adopted and the material to be used].

The whole of the above-mentioned works to be executed by you in accordance with the plans and sections hereinbefore referred to, and now lying for inspection by you at the office of [insert description of sanitary authority] situate in street, in

aforesaid, and the dimensions, widths and levels shown thereon, and to be done in a good, workmanlike and substantial manner, to the satisfaction of the said [insert description of sanitary authority] or their surveyor.

Dated this hundred and

day of

one thousand eight

THE [insert description of sanitary authority], being the local authority under the above-mentioned

G.

M

act, do by this order under their hands and seal discharge the inheritance or fee of the premises mentioned in the schedule hereto, with the payment to

of the sum of

day of

pounds, payable yearly on the -, for the term of

years,

and being in consideration of an expenditure of pounds incurred by him in respect of the said pre

mises.

Schedule.

[Insert description of premises charged.]

No. XL. Form of Order by Court of Quarter Sessions or Petty Sessions.

BE it remembered that on the

day of

187-, upon the report hereinafter mentioned, we, the undersigned justices assembled at the court of quarter sessions holden in and for the county of [or, assembled in petty sessions for the division or district of the borough or county of as the case may be], do hereby order and determine that one or more house or houses, or buildings situate in a certain court or alley within the borough, known or designated as court or alley [or otherwise distinguishing the premises], and specified in the report of the officer of health for the

dated the

day of

187-, is or are unfit for human habitation, and ought to be improved or demolished [as the case may be], in pursuance of the Artizans and Labourers Dwellings Act, 1868.

No. XLI. Form of Notice by Clerk of the Peace or Clerk of the Justices to Clerk of Sanitary Authority.

Artizans and Labourers Dwellings Act, 1868.

I, A. B., clerk of the peace, or clerk of the justices do hereby certify, that on the

for the day of

court of quarter sessions for the

187, the justices assembled at the sessions, or assembled at the petty

, [as the case may be], made

an order, of which the following is a true copy:

[Here give a copy of the presentment, Form 11.]

UNDER THE COMMON LODGING HOUSES ACTS.

No. XLII. Form of Notice.

act, called "The Common Lodging Houses Act, 1851," was passed, and that before the --day of you, being the keeper of a common lodging house within [here state the place over which the jurisdiction of the sanitary authority giving the notice extends], must have your common lodging house registered, and that the register is to be kept at [here state

where the register is to be kept], and that if you do not have your common lodging house so registered you will be liable to a penalty not exceeding five pounds for every lodger whom you receive in your common lodging house while it is not so registered, and that on your applying to [here give the name and address of the person to keep the register], he will register your common lodging house free of all charge to you. Dated

UNDER THE NUISANCES REMOVAL ACTS.

No. XLIII. Order of Justices for Admission of Officer of Sanitary Authority to Inspect Private Premises.

WHEREAS [describe the sanitary authority] have, by their officer [naming him], made application to me, A. B., one of her majesty's justices of the peace having jurisdiction in and for [describe the place], and the said officer has made oath to me of his belief that a nuisance, within the meaning of the Nuisances Removal Act for England, 1855, viz. [describe nuisance], exists on private premises at [describe situation of premises so as to identify them], within my jurisdiction, and demand of admission to such premises for the inspection thereof has been duly made under the said act, and refused.

Now, therefore, I, the said A. B., do hereby require you to admit the said [name the sanitary authority],

[or the officer of the said (sanitary authority)], for the purpose of inspecting the said premises.

Dated this

day of

187-.

A. B.

No. XLIV. Notice of Nuisance.

To the Sanitary Authority (describing them). I [or we], the person aggrieved by the nuisance hereinafter described [or the undersigned and described inhabitant householders, inspector of nuisances, or other officer (describing him)], do hereby give you notice, that there exists in or upon the [dwellinghouse, yard, &c. as the case may be], situate at [giving such description as may be sufficient

to identify the premises], in the parish of in your district, under the Public Health Act, 1872, the following nuisance, videlicet [describing the nuisance, as the case may be; for instance, a dwelling-house or building a nuisance or injurious to health for want of a privy, or drain, or sufficient means of ventilation, or so dilapidated or so filthy as to be a nuisance or injurious to health, or, for further instance, a ditch or drain so foul as to be a nuisance or injurious to health, or an accumulation of a nuisance or injurious to health, &c., or swine, or, &c. so kept as to be a nuisance or injurious to health]; and that such nuisance is caused by [naming the person by whose