Required fields are marked with asterisks (*)

Short Term Accommodation Owner Authorization Form

This form is only required if a person other than the property owner is completing the application and may be contacted to discuss matters on behalf of the owner.

Email address

Roll Number

Property Address

I hereby authorize

to submit a short term accommodation (STA) licence application pursuant to By-law 2021-84, for the above-noted address, along with any required supporting documentation, to the Municipality of Northern Bruce Peninsula, on my behalf. I hereby certify that I have reviewed the completed Short Term Accommodation Licence Application, supporting documentation and declarations, confirm them to be true and correct, and agree to be bound thereby. I further declare that I understand it is my responsibility to ensure that this property is at all times in compliance with all applicable laws, including but not limited to the Building Code Act, the Fire Protection and Prevention Act, the Electricity Act, and regulations made under them.

Owner name

Signature

Clear

Date

Personal information on this form is being collected under the authority of the Municipal Act, 2001, and will be used for the purpose of determining eligibility for a Short Term Accommodation Licence, pursuant to applicable by-laws. This information may be shared with related agencies for the purpose of required inspections, approval of and compliance with this licence application. Questions regarding the collection of this information should be directed to the Clerk at 1-833-793-3537 ext. 236.