Government of Ontario: Ministry of Transportation

Application for Building and Land Use Permit / Entrance Permit

1. Building and Land Use Application

Application is hereby made to:
Erect Alter Place Repair
A Building A Structure
Other (Briefly Describe)

Use the land described below for a detailed description of development

2. Entrance Permit Application

Application is hereby made to:

Construct an:
Unpaved entrance Paved entrance

Pave an existing entrance
Change of ownership
Change of business
Construct curbs, gutters or other permanent works related to an entrance
Change the design of an existing entrance
Relocate an existing entrance
Change of classification (i.e. residential to commercial, etc.)
Construct a temporary entrance or use any part of the right-of-way of a highway as means of temporary access to and from a property with an expiry date of:

3. Registered Owner

Name

Telephone No. ( )

Address
City/Town/Village
Province
Postal Code

4. Location of Property

Lot. No./Con. Plan No./Section
Township/City
County/District/Regional Mun.
On the (N.S.E.W.)side of
Highway No. (or Name)
About (distance) km mi.
N.S.E.W. of
Nearest Town, Village or Intersection

5. Description (Building, Structure, Planting, Powerline)

A detailed plan showing location of building, addition, highway, road, entrance, etc. must accompany each application.

Size Metres Feet

Parking area available sq. m sq. ft.

Distance from highway property line or centre line Metres Feet

Clear visionat entrance to highway Metres Feet

Name and location of nearest public road intersecting highway

Indicate which of the following is required / will be affected, if any:
Drainage
Gravel entrance
Paved entrance
Culvert/Pipe
Other items

The area to which this application applies is zoned for:
Farm Residential Commercial

This proposed building etc. will comply with the zoning regulations

6. Use of Entrance

A detailed plan showing location of building, addition, highway, road, entrance, etc. must accompany each application.

Detailed description of type of establishment served by entrance:

Access required for
Proposed material

Approximate distance approaching traffic visible from the point of entrance to the highway From the right Metres Feet

From the left Metres Feet

Indicate which if any of the following will be affected:
Wetland (lands that are seasonally or permanently wet)
Watercourse/waterbody: Permanent or intermittent; standing or flowing
Groundwater upwelling (springs, seepage areas)
Fish or fish habitat
Highway drainage system
None of the above
Trees/shrubs
Guide rail
Highway sign
Other

It is understood that all works will be constructed, altered, maintained or operated at the expense of the undersigned, and that work must not begin before a permit has been issued by the Ministry. The issuance of a permit by the Ministry does not relieve the holder 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, Her Majesty the Queen, represented by the Ministry of Transportation from and against all loss, cost, damages, expenses, claim and demands whatsoever to which Her Majesty may be put or which She may be liable by reason of anything done or omitted to be done in the construction, maintenance, alteration or operation of the works authorized. The Minister may issue permits upon such terms and conditions as deemed proper and may cancel any such permit at any time.

A fee in the amount of $ is enclosed. Please make cheques or money orders payable to the Minister of Finance.

Name

Telephone No. ( )

Address
City/Town/Village
Province Postal Code

Signature

The signature of the registered owner or his authorized agent must be affixed to each application.

Date (yyyy/mm/dd)

Information in this form is collected under the authority of the Public Transportation and Highway Improvement Act, R.S.O. 1990, c. 50, s. 31, 34, 38, and is used to control and record the issuance of this permit. Direct inquiries to: Senior Policy Adviser, Operations Office, 2nd Floor, 301 St. Paul Street, St. Catharines, Ontario L2R 7R4, Telephone: 905 704-2916.