Culvert-Entrance Permit Application

Required fields are marked with asterisks (*)

Entrance Construction Permit Application

This form is authorized under the Driveway, Entrance and Boulevard By-law 2022-31

A. Project Information

Street Address:

Unit No.:

Lot/Con:

Municipality:

Postal Code:

Plan Number:

Estimated Project Value: $:

Area of Work (m2) or width of Proposed Entrance/Driveway (m):

B. Purpose of application

Select all that apply:

New Entrance/Driveway

Alteration to existing Entrance/Driveway

Alteration to Boulevard

Curb Cut

Replacement Culvert

Please enter N/A if not applicable:

Current Driveway Width (m):

Proposed Driveway Width (m):

Proposed Culvert Width (m):

Proposed Culvert Diameter:

Proposed Culvert Material:

Description and Purpose of Proposed Work:

C. Applicant/Contractor

Applicant is (select one):

Last Name:

First Name:

Corporation or Partnership:

Street Address:

Unit No.:

Lot/Con:

Municipality:

Postal Code:

Province:

Telephone Number:

Cell Number (if different):

E-mail:

D. Owner (if different from applicant)

Last Name:

First Name:

Corporation or Partnership:

Street Address:

Unit No.:

Lot/Con:

Municipality:

Postal Code:

Province:

Telephone Number:

Cell Number (if different):

E-mail:

E. Checklist

Select all that apply (please note that the fee/deposit is to be paid at the Township Office, 318 Canborough St, Smithville, ON, L0R 2A0):

Site Plan Sketch

Certificate of Insurance naming The Corporation of the Township of West Lincoln as additional or co-insured minimum $2,000,000.00 for residential permits and $5,000,000.00 for commercial/industrial permits

W.S.I.B. Clearance Certificate (If a Contractor will be completing the work)

Location of work staked

Applicable fee ($150.00 regular fee, doubled if work done without permit)

Applicable deposit ($1,250.00)

F. Declaration of applicant

As the applicant (enter name), I declare that:

Date:

1. The information contained in this application, attached schedules, attached plans and specifications, and other attached documentation is true to the best of my knowledge.

2. If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership.

Please attach all relevant documents:

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Please note your application will not be reviewed until payment has been received and all required documents are submitted. Provide information here if you are submitting documents separate to this application.

Conditions of Approval

THIS PERMIT IS SUBJECT TO THE FOLLOWING CONDITIONS AND TO ANY SUPLLEMENTARY CONDITION ESTABLISHED BY THE TOWNSHIP AT THE TIME OF ISSUE:

This entrance permit is subject to all applicable Municipal By-laws
Work on the construction or alteration of an entrance must not be started before an entrance permit for the work has been issued by the Township.
All works related to or forming a part of an entrance shall be carried out in accordance with the approved plans and specifications and subject to the approval of the Township. The owner of the property shall bear all expense related thereto.
Trees, shrubs, etc. on the right-of-way and a highway must not be cut or trimmed without the written permission of the Township and such cutting or trimming may only be done under the direct supervision of the Township or its duly authorized agent; where it is necessary to cut or trim trees on property adjacent to a highway, the applicant must make the necessary arrangements with the property owners and must bear all expenses and liability in connection therewith, including any damages occasioned as a result of such cutting or trimming.
The owner of a property served by an entrance shall maintain each entrance to the property in accordance with the minimum requirements of the Township.
The property owner is responsible for the maintenance of that portion of any entranceway lying between the edge of the pavement and the property line including replacement/repair of the culvert.
An entrance permit may be cancelled at any time for breach of the regulations or conditions of the permit or for such reasons as the Public Works Department in their discretion deems applicable.
The applicant agrees for himself/herself, itself, his/hers/its heirs, executors, successors and administrators to indemnify and save harmless the Corporation of the Township of West Lincoln from any action, claim, damage, cost or loss whatsoever, arising from operations carried out under this permit.
A valid Certificate of Insurance, in a form acceptable to the Corporation of the Township of West Lincoln, with respect to liability for property damage and personal injury for a minimum amount of $2,000,000.00 for Residential permits, and $5,000,000.00 for Commercial/Industrial permits for any one accident or occurrence and the Certificate of Insurance shall name The Corporation of the Township of West Lincoln as additional insured or co-insured and remain in force until the Township approves the work.
When submitting the application, a copy of the Certificate of Insurance (as outlined in #9 above), a fee of $1400.00 (which includes a $150.00 application fee and $1250.00 deposit) and a sketch or map of the proposed entrance is required. If you are hiring a contractor to complete the work, a W.S.I.B. Clearance Certificate will also be required.
Utility locates are mandatory and are the sole responsibility of the applicant.
This permit is valid for a period of 1 year from Township approval.

Personal information collected will be used for the purposes indicated only in accordance with the Municipal Freedom of Information & Privacy Act. Questions regarding the collection of personal information may be directed to the Office of the Municipal Clerk.

Form Builder

Entrance Construction Permit Application

A. Project Information

B. Purpose of application

C. Applicant/Contractor

D. Owner (if different from applicant)

E. Checklist

F. Declaration of applicant

Conditions of Approval