Required fields are marked with asterisks (*)

Application for Draining Into, Piping and/or Filling of a Roadside Ditch

Please see the Policy and Procedures for Draining Into, Piping and/or Filling of Roadside Ditches document for further information.

Application Fee

$750.00 - security deposit is to be presented to the Municipal Office. $500.00 of the said fee may be refunded after the Public Works Manager and/or their designate has carried out an onsite inspection and approval has been granted for the refund.

Description and Location of Property

Lot number:

Concession or Plan number:

Assessment Roll Number:

Street address:

Purpose and detail of draining into, piping and/or filling of a roadside ditch:

Required for:

Diameter of pipe/culvert:

Type of pipe (CSP, Big "O", etc.):

Indicate whether the following items have been addressed and how:

Subsurface draining

Surface draining

Sufficient outlet

Rodent protected

Damage to Municipal property

It is understood that all works will be constructed, altered, maintained and/or operated at the owner's expense and that no work shall commence until a permit has been issued. The issuance of this permit does not relieve the holder of the responsibility of complying with municipal by-laws.

It is also understood that the applicant has read and understands the plicy and procedures for Draining Into, Piping and/or Filling of a Roadside Ditch, and agrees to the terms set forth in the policy.

In consideration of this Application, I/we the applicant(s) hereby agree to observe and comply with regulations set forth in this permit and save harmless the Municipality from all costs, charges, damages and claims whatsoever to which may arise from the issuance of this permit.

Failure to comply with terms set out in this permit shall warrant removal of said construction at the owner's expense.

Date:

Name:

Address:

Telephone number:

Signature of applicant:

Clear

Contractor conducting work:

Contractor's telephone number:

For Office Use Only

Comments:

Signature of Municipal official:

Clear

Date:

Date of Expiry of Permit:

Personal information on this form is collected under the authority of the Municipal Act, 2001, and will be used for the purpose of responding to your application. Questions regarding the collection of this information should be directed to the Clerk at 1-833-793-3537 ext. 236.