Entrance Permit Deposit

Name of Person Paying for Deposit *

First

Last

Mailing Address of Person Paying for Deposit *

Address Line 1

Address Line 2

City

Province

Postal Code

Email Address of Person Paying Deposit *

Phone number of Person Paying for Deposit

Address of Entrance Permit

Address Line 1

Address Line 2

City

Province

Postal Code

Roll Number of Entrance Permit Property *

Entrance Permit File Number *

The file number has been provided in the email with the link to this deposit form.

Entrance Permit Deposit

Price: $1,000.00

Terms and Conditions

I agree that I have reviewed and understood the Township’s Entrance By-Law 032/2020 and further that I will comply with all requirements set out in that By-Law.

I agree that I have read and understood any conditions imposed on the entrance permit. application listed under terms and conditions

I understand that in order to ensure installation standards are met and professional construction techniques are employed and that no damage has occurred to the Township road, an Entrance Permit Deposit is required. This deposit is refundable after final inspection, if the construction and restoration are complete and no deficiencies exist and where no damage to the Township road has been caused. Should the Township be required to make repairs, complete the construction or remove the entrance at any time as deemed necessary by the Director of Public Works, Parks and Facilities or designate, associated costs shall be deducted from the below noted deposit. Further costs, if incurred by the Township with respect to the road damage, shall be invoiced to the property owner and may be added to the tax roll and collected in the same manner as taxes on the property.

I have read, understand, and will comply with the attached General Terms & Conditions which form part of this permit application.

Terms and Conditions *

I agree to the terms and conditions.
I understand and confirm that the person paying for the entrance permit depsoit will be the same person receiving the entrance permit deposit refund.

Convenience Fee

Price: $17.50

A convenience fee of 1.75% is applied to all online payments. Please note that the convenience fee is not refundable. All deposit refunds will be provided by cheque to the person(s) paying the deposit listed on this form to the mailing address provided.

Total

$0.00

Stripe Credit Card *

Card

Name on Card

Personal information on this form is collected under the authority of the Municipal Act and will be used to determine the eligibility of a permit. The information is used for the purpose of processing this application and administering the entrance permit program and is maintained in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information may be directed to the Township Clerk’s office.

The Township of Puslinch is committed to providing accessible formats and communication supports for people with a disability. If another format would work better for you, please contact the Township Clerk’s office for assistance.