Site Alteration - Application for more than 500m3 Per Year of Fill
Please complete all applicable sections of the appication form. An incomplete application will not be processed. Please click the submit button when completed or return completed forms to the Director of Planning and Building and/or he Director of Public Works and Engineering.
Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif
The owner must complete this section. For more than one owner, please fill out an additional seperate section for each owner.
to submit the above application to the Township of West Lincoln for approval thereof.
In accordance with the provisions of the Municipal Act, as amended, I understand that all information and material that is submitted with any application may be made available to the public, and specificially any application to Council relating to a site alteration in excess of 1000 cubic metres shall become part of the public record.
In submitting this application and any supporting materials or information, I hereby acknowledge the above-noted and provide my consent.
Further, I understand and acknowledge that my application will be shared with the Niagara Peninsula Conservation Authority.
Note: Original signature(s) are required for the record. In the case of a corporation, the signature(s) must be that of an officer(s) with authority to bind the corporation.
The applicant acknowledges that a site walk may be required in order to view the property and its relation to the surrounding lands, and in this regard authorizes members of Council (or a representative thereof), Township staff, Peer Review Consultants retained by the Township, and relevant External Agency Review Staff to enter onto the subject property for the purpose of evaluating the merit of the application, at an arranged time.
Owners(s)/Agent(s) Signature
Note: Original signatures(s) are required for the record. In the case of a corporation, the signature(s) must be that of an officier(s) with authority to bind the corporation.
The applicant certifies to have read the Site Alteration By-law and Schedules and agrees to abide by all the conditions therein; and,
The undersigned certifies to the Township that any and all Fill used in completing the Site Alteration contains no contaminants within the meaning of the Environmental Protection Act, R.S.O. 1990, c.E. 19. The undersigned hereby releases and agrees to indemnify and save harmless the Township, its employees, representatives, agents and contractors, from and against all claim, demands, damages, causes of action, costs, expenses and other liabilities of any nature, which may arise in the event that the Fill is determined to contain contaminants.
hereby make the above application for Site Alteration, declaring that all information contained herein is true and correct, and acknowledge the Township of West Lincoln will process the application based on the information provided.
For Office Use Only
Completed Application Recieved:
Application Approved for Receipt:
Approved By:
Site Aleration Permit Issued:
Permit Issued By:
Contact Us