Required fields are marked with asterisks (*)

Road Occupancy Permit

Permit Fee: $250.00

Entrance Bond: $1,000.00 (Refundable)

Work Under Roadway Bond: $1,000.00 (Refundable)

Please note: permit fee is waived for municipal drains.

Name of Contractor:

Contractor's contact number:

Contractor Contact Person:

Contractor's email address:

Contractor's address:

Name of Sub Contractor(s)

Sub Contractor(s) Contact Number

Sub Contractor(s) Contact Person

Sub Contractor(s) Email Address

Sub Contractor(s) Address

Property Owner's Name:

Property Owner's Mailing Address:

Property Owner's Postal Code:

Property Owner's Contact Number:

Property Owner's email address:

Civic Address and Road Name:

Lot number:

Concession number:

Township:

Severance Application No.:

Description of Work:

Distance from the road centerline:

Linear distance of install

Proposed start date:

Estimated completion date:

Please upload a plan/sketch showing location of above described work.

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