Township of West Lincoln

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.

Property Information

Municipal Address

Registered Land Owner

Consultant Information

Contractor Information 

Type of Work 

Financial 

Permit Fees

• Application Fee (500m³/year to less than 1000m³/year) - $500.00
• Application Fee (1000m³/year or greater) - $1000.00
• Road Damage Deposit - not to exceed $5000.00

Owner Authorization (if an agent is used)

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.

Consent for Release of Information

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.

Permission to Enter

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.

Important Information 

• The security deposit will be refunded to the individual/company who provided initial payment following a final inspection by Township staff.  Please note that the deposit will applied to an unpaid taxes and/or water and sewer charges.  Any applicable fee, municipal services fee, and agreement preparation fee are non-refundable.  The deposit will be refunded upon cancellation of a permit, less the administration fee, provided that no work has been commenced. 
• The owner hereby authorizes the Township of West Lincoln to enter onto the subject lands for the purposes of inspection or with labour and equipment to complete or repair any works as deemed necessary by the Township.
• The Township of West Lincoln may engage legal, engineering,  hydrology, environmental, arborists, landscape or any other consultant as deemed necessary by the Director of Planning and Building in order to evaluate studies and/or agreements in which case the costs incurred for such evaluations shall be charged back to the applicant.
• Fees shall be adjusted upon completion of work where required to reflect totals based on accurate fill volumes verified by a professional engineer prior to final clearance.
• It is the landowner's responsibility to obtain all necessary approvals from any federal, provincial, regional or municipal agencies, including the conservation authority, prior to providing application for a site alteration permit. 

Applicant Certification 

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: