Entrance Permit Application - Township of Puslinch

Applicant Information

Applicant Name *

First

Last

Mailing Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Email Address *

Phone Number *

Description and Location of Property

Name of Property Owner *

First

Last

Road Name *

Lot Number *

Concession or Plan Number *

Application is hereby made to

Check one or more of the following:

Application is hereby made to *

Construct an unpaved entrance
Construct curbs, gutters or other permanent works related to an entrance
Construct a paved entrance
Pave an existing entrance
Add curbs, gutters, or other permanent works to an existing entrance
Change the design of an existing entrance
Change the location of an existing entrance
Use an existing entrance for other than its original, present, or normal use (change of classification from residential to commercial, etc.)
Construct a temporary entrance or use any part of the right of way of a Municipal Road as a means of temporary access to and from a property

Classification, Use, Purpose, and Detail of Entrance

Is this a condition of an active severance application? *

Yes
No

Access Required for *

Number of Entrances *

Material Proposed for Use *

It is understood that all works will be constructed, altered, maintained, or operated at the expense of the undersigned. It is understood that work must not begin before the Township has issued a permit. The issuance of a permit by the Corporation of the T ownship of Puslinch (“T ownship”) does not relieve the owner/applicant of the application of the responsibility of complying with relevant municipal by-laws. In consideration of any permit issued in respect to this application, we, the applicants for ourselves, our heirs, executors, administrators, successors, and assigns, hereby agree to observe, keep and perform and be subject to the regulations and conditions of the said permit and to indemnify and save harmless the Township from and against all loss, cost, changes, damages, whatsoever to which may be put or which the Township may suffer or sustain or for which the Township may be liable by reason of anything done or omitted to be done in construction, maintenance, alteration or operation of the works authorized.

Drawing *

Click or drag a file to this area to upload.

Please provide a sketch of the location of the proposed entrance. Show entrance in proximity to existing buildings, driveways, roads, etc. North arrow should be shown. Use dark ink. *Please mark the proposed entrance clearly with stakes for inspection purposes

Signature *

Authorization by Owner

Owner is different than applicant

Owner is different than applicant

If an application is signed by an individual other than the owner, the owner’s written authorization shall be completed below.

Owner's Name *

First

Last

Owner's Address *

Address Line 1

Address Line 2

City

Province

Postal Code

I authorize this person to act as my agent in this application *

First

Last

Owner's Signature

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.

Applicant Information

Description and Location of Property

Application is hereby made to

Classification, Use, Purpose, and Detail of Entrance

Authorization by Owner

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