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 *

Name of Property Owner *

First

Last

Entrance Location

Road Name *

Lot Number (if known)

Roll Number (if known)

Concession or Plan Number (Legal Description) *

Civic Address Sign (if assigned)

If civic address is unassigned what is the closest neighbouring civic address? *

Entrance Location Staked *

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? *

Please note, only one residential entrance is permitted per lot. If an entrance permit is a requirement of a condition of consent, please contact the Clerks Department.

Severance Number:

Number and Type of Existing Entrances *

Material Proposed for Use for Entrance Apron (e.g., asphalt, gravel, etc.) *

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. Show proposed location of the entrance and distance from property lines. *Please mark the proposed entrance clearly with stakes for inspection purposes.

Terms and Conditions

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

I understand further requirements may be imposed upon initial inspection to be included as conditions to the approved permit. This may include the addition of culverts, drainage, or other conditions imposed based on development approvals.

I understand that a sketch or drawing must be included with this application showing the location and size of the property.

I understand that entrance permits expire one (1) year following the date of issue. Entrance permits not completed within the one (1) year forfeit the full application fee. A new application must be made with an additional application fee in accordance with the Township’s User Fees and Charges By-Law.

I understand that the Township must be notified at least two (2) business days prior to the commencement of any construction.

I understand that it is the responsibility of the owner/applicant to ensure that the construction of the entrance is in accordance with the requirements of all applicable regulatory agencies having jurisdiction. Contact the Clerks department for more information if required.

I understand that a minimum of two (2) inspections are required: the initial inspection is to take place prior to the issuance of the permit; a final inspection must be scheduled once construction is complete in order for any deposit to be returned. It is the responsibility of the owner/applicant to schedule the final inspection with the Township. Please contact the Clerks Department to schedule an inspection.

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, understood, and will comply to the attached General Terms & Conditions which form part of this permit application.

Terms and Conditions *

I agree to the Terms and Conditions.

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 first inspection has been completed and the Township has issued a permit. The issuance of a permit by the Corporation of the Township of Puslinch (“Township”) 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.

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.

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.