By-law Compliance Deadline Extension Request

Fill out the form below or download the printable PDF form.

Applicant's Name *

First

Last

Applicant's Phone Number

Applicant's Email *

Applicant's Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Address/Location of Subject Property *

Address Line 1

Address Line 2

City

Province

Postal Code

Reason For Requesting an Extension

Note: Please be advised that an extension can’t be provided for Property Standards Orders.

Please state the reason why you are requesting an extension to the imposed deadline: *

What is the duration of extension you are requesting? *

Attached Pictures or Supporting Documentation

Click or drag files to this area to upload. You can upload up to 5 files.

Declaration

I, hereby declare that the information given in this form is true, complete, and accurate.

Signature *

Clear Signature

Date *

Personal information on this form is collected under the authority of the Municipal Act 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.

Reason For Requesting an Extension

Declaration

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