Application For Fill And Site Alteration

Made under the Provisions of By-law 201-96

Please Complete This Section:

PERMIT NO:

(Location) Site Name:

(Location) Construction Address:

(Location) Legal Description:

(Schedule) Construction Start Date:

(Schedule) Completion Date:

(Consulting Engineer) Name of Firm:

(Consulting Engineer) Address:

(Consulting Engineer) Contact Person:

(Consulting Engineer) Phone Number:

(Contractor) Name of Firm:

(Contractor) Address:

(Contractor) Contact Person:

(Contractor) Phone Number:

(Owner) Name of Owner:

(Owner) Address:

(Owner) Contact Person:

(Owner) Phone Number:

This application shall be accompanied by the following:

MINOR ALTERATION	MAJOR ALTERATION
Three (3) copies of the proposed site alteration plan by a qualified person	Three (3) copies of the proposed site alteration plan certified by a professional engineer or an Ontario Land Surveyor registered to practice in the Province of Ontario
Permit Fee $	Permit Fee $
Other	Letter of Credit in the amount of $
	Environmental Audit of the materials being imported
	Proof of Insurance

Land Use Information

Residential

Commercial

Industrial

Institutional

Other

APPLICATION FOR FILL AND SITE ALTERATION

Part 2

Is there an existing building on the lot?

What is the use of the building?

Is there a septic system on site:

Fill Material

Where does the fill material come from?

Description of material:

Has an environmental audit been performed on the material?

Estimated value of the proposed alteration $:

Approximate number of loads to be taken to the proposed site:

Number of full loads:

Number of ½ loads

Brief description of the route to be taken during the course of construction:

Declaration

I, hereby grant the Town of Fort Erie permission to enter unto the subject lands to conduct inspections of the proposed work for which this permit was issued, and hereby solemnly declare that all the statements contained in this application are true and I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.

Owner Email:

Owners Signature:

Clear

Date: