Government of Ontario: Ministry of Transportation

Application for Sign Permit

A Separate Application Is Required for Each Sign Unit.

Application is hereby made to

Erect a Sign Alter a Sign Relocate a Sign Change Ownership

Type of Sign
Location (Business) Billboard on Highway Personal Direction GRR-2 Other
Billboard on Private Property Private Roadway GRR-1 Temporary Sign Municipal Decorative Display

Wording, Symbols or Pictures on Sign

Enclose sketch or picture to properly describe sign, location on property, relationship to highway, etc.

Description of Sign

Highway Frontage Feet Metres

Number of existing signs

Total area of existing signs Sq. Feet Sq. Metres

Lot. No./Con.
Plan No./Section
Township/City
County/District/Regional Municipality
Highway No. (or Name)
Facing (N.S.E.W.) On the (N.S.E.W.) side

About (distance) Miles Kilometres

N.S.E.W.
Nearest Town, Village or Intersection

Width Feet Metres

Height of actual sign Feet Metres

Height from ground to top of sign Feet Metres

Surface area including border Sq. Feet Sq. Metres

Distance from sign to highway properly limit Feet Metres

Number of Signs

Distance from edge of pavement Feet Metres

Registered Property Owner

Name

Telephone No.
( )

Address City/Town/Village
Province Postal Code

The applicant understands that: (1) All work will be performed at the expense of the applicant. (2) Work must not be begun before a permit is issued. (3) The issuance of a permit does not relieve the applicant of the responsibility of complying with relevant municipal by-laws. (4) If a permit is issued it relates only to the sign as described in the permit. By signing this application the registered property owner gives M.T.O. permission to enter on the land to remove any sign that is altered or is not maintained in good repair according to M.T.O. requirements and for non-payment and cancellation.

In consideration of a 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 idemnify and save harmless Her Majesty the Queen, represented by the Minister of Transportation from and against all loss, cost, damages, expenses, claims 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.

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

Business Name(please print in block letters
Business Address (please print in block letters
City/Town/Village
Province Postal Code

Telephone No.
( )

Fax No.
( )

Signature (Applicant or responsible officer of firm)

Date (yyyy/mm/dd)

Signature (Property Owner)

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.

PH-A-17-E (03/2007)

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