Town of Northeastern Manitoulin and the Islands

Town of Northeastern Manitoulin and the Islands

Entrance Application

Application is hereby made to:
Construct an:  Unpaved entrance  Relocate an existing entrance  Construct curbs, gutters or other permanent works related to an entrance
 Construct a temporary entrance or use any part of the right-of-way of a roadway as a means of temporary access to and from a property
Expiry Date: ______

Registered Owner

Name: ______Address: ______
______
City: ______Prov: ______Postal: ______Phone: ______

Location of Property and Proposed Entrance

Lot/Con: ______Plan #: ______Township: ______
On the ______side of the roadway ______about ______kilometres/miles
N.S.E.W.
______of ______
N.S.E.W. (e.g. nearest public road intersection)
Use of Entrance (detailed description of type of establishment served by entrance)
______
______
Access required for: ______Proposed material: ______
Proposed culvert size: ______diameter ______length
Indicate which if any of the following will be affected:
 Trees, plantings, shrubs  Guide Rail  Hwy Sign  Existing Culvert  Other: ______
(A detailed plan must accompany each entrance application – see reverse side).
It is understood that all works will be constructed, altered, maintained or operated at the expense of the undersigned, that work must not begin before a permit has been issued by the municipality. The issue of a permit does not relieve the holder of the responsibility of complying with relevant Municipal By-Laws. In consideration of any 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 regulation and conditions of the said permit and to indemnify and save harmless The Corporation of the Town of Northeastern Manitoulin and the Islands from and against all loss, cost, damages, expenses, claims and demands whatsoever to which the municipality may be put or which it may be liable by reason of anything done or omitted to be done in the construction, maintenance, alteration or operation of the works authorized. The Municipality may issue permits upon such terms and conditions as it considers proper and may at its discretion cancel any such permit at any time.

Fee

A fee in the amount of $118 plus HST is enclosed, made payable to the Town of Northeastern Manitoulin and the Islands.
Name: ______Address: ______
City: ______Prov: ______Postal: ______
Signature: ______, the signature of the registered owner or authorized agent must be affixed to each application.

For Office Use Only

Approval of this application for an entrance permit is hereby granted, subject to the following conditions:
______
______
______
______
______
______
Signature: Public Works Supervisor Date
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: the Public Works department, P.O. Box 608, Little Current, ON P0P 1K0 Tel: (705)368-2093 Gary May

Town of Northeastern Manitoulin and the Islands

Entrance Permit Application – Plan
Applicant Name: ______
Plan should provide sufficient detail to facilitate on-site inspection by Municipal Staff, including locations of existing trees/shrubbery, fences, mail boxes, culverts, drainage flow, utility poles, intersection, entrance, buildings within 100’ (30 m) radius of the proposed entrance. Drawing should indicate direction to North, preferably at the top of the sketch.

F:\CLERKS OFFICE\FORMS\EntrancePermitApplication16.doc