Noise By-law Exemption Application

A person may apply to Council to be granted an exemption from any of the provisions of the Noise By-law through the issuance of a Permit.

Applications for the issuance of a Noise Exemption Permit must be submitted 60 days prior to the commencement of the requested exemption.

Name *

First

Last

Phone *

Email

Please describe the noise for which an exemption if being requested.

E.g. Live band, amplification system (speakers), etc.

Starting Date/Time of Exemption Request *

Date

Time

Ending Date/Time of Exemption Request *

Date

Time

Address for the exemption *

Address Line 1

Address Line 2

City

AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonProvince

Postal Code

Letter of consent from the property owner (if applicable)

Click or drag a file to this area to upload.

Please indicate the provision(s) of the By-law for which an exemption is being sought. *

E.g. “Schedule A – Instruments/Human – amplification of sound past 11:oo p.m.”

Please provide a detailed explanation as to why you believe the exemption should be granted. *

Has a special event permit been applied for? *

• Yes
• No

Contact Information for Responsible Person

Please identify the name and contact information below for the person who will be responsible for supervising activites for which the exemption is being sought and will be available to address any concerns.

Name of responsible person *

First

Last

Phone Number of responsible person *

Email of responsible person

Submit

Personal information on this form is collected under the legal authority of the Municipal Act, S.O. 2001, c.25 as amended. The information is collected and maintained for the purpose of creating a record pursuant to Section 27 of the Municipal Freedom of Information and Protection of Privacy Act. Questions about this collection should be directed to the Clerk’s Office. 519-763-1226 ext. 5.

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.