Site Alteration Application Assessment

In accordance with the Township’s Site Alteration By-law 2023-057 there are five application types:

• Normal Farm Practice Waiver
• Minor Site Alteration Application
• Intermediate Site Alteration Application
• Large Site Alteration Application
• Major Site Alteration Application

In order to assist applicants with submitting the correct Site Alteration Permit Application, please complete the application assessment below. Staff will follow-up with the corresponding Site Alteration Application form within 3 business days.

Property Owner's Name *

First

Last

Property Owner's Phone Number *

Property Owner's Email Address *

Property Roll Number

Example 23-01-000-000-00000-0000

Property Address *

Address Line 1

Address Line 2

City

OntarioAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonProvince

Postal Code

Are you submitting on behalf of the property owner? *

• Yes
• No

Contractor Name *

Contractor Address *

Address Line 1

Address Line 2

City

AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonProvince

Postal Code

Contractor Phone Number *

Contractor Email Address *

Is any part of the site alteration taking place in a Conservation authority regulated area? *

• Yes
• No

Please note that if the property is in an area regulated by a Conversation Authority, you will require additional permit approvals from the relevant Conversation Authority.

What is the zoning of the property? *

What is the current use of the property? *

Ex. Business, residential, farming purposes.

What is the size of the property in hectares? *

What is the size of the proposed site alteration work area in hectares? *

Provide a brief description of the Site Alteration project. *

Does any part of the site contain a watercourse? *

• Yes
• No

Is the proposed site alteration area within 30 metres of a watercourse? *

• Yes
• No

Is the site alteration area a minimum of 30 metres from all property boundaries and drainage swales? *

• Yes
• No

Are trees being removed as part of the Site Alteration project? *

• Yes
• No

Please note that if trees are being removed additional permits or approvals from the County of Wellington may be required.

Is the Site Alteration Permit associated with a building permit? *

• Yes
• No

Is the Site Alteration Permit associated with an approved Site Plan Control Agreement? *

• Yes
• No

Is this related to a By-Law Enforcement order? *

• Yes
• No

Please be advised that in accordance with Site Alteration By-law 2023-057 this Site Alteration Permit application is subject to double permit fees.

What is the source of fill for this project? *

• Imported fill (Imported from secondary location)
• Native fill (Fill that is being moved from one part of the subject property to another)

Describe the material of the fill. *

What is the volume of Fill being imported from off-site in cubic metres? *

Has fill already been imported to the property? *

• Yes
• No

How much Fill has been imported to the site in cubic metres? *

Is fill being removed from the subject property as part of this permit? *

• Yes
• No

How much fill is being removed? *

What is the largest change in grade associated with this application in metres? *

Upload any preliminary drawings or documents

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

I understand that this is an assessment form for a Site Alteration Permit and is not considered an application. As a result of completing this form staff will advise which Site Alteration Permit Application type and supporting documents are to be submitted.

• I have read the above and understand this requirement.

Signature *

Clear Signature

Name

Submit