Required fields are marked with asterisks (*)

Application for Site Plan Control

Your Property Tax Roll #

1. NAMES

1.a. i) Registered Owner (Name):

Address of Registered Owner:

Registered Owner Telephone # :

Registered Owner Cell Phone # :

APPLICANT Email Address:

Registered Owner Email Address:

1.a. ii) Authorized Agent or Solicitor Name (If applicable):

Address of Agent or Solicitor:

Agent/Solicitor Telephone # :

Agent/Solicitor Cell Phone # :

Agent/Solicitor Fax # :

Agent/Solicitor Email Address:

1.c. i) All correspondence should be sent to:

Owner

Agent/Solicitor

1.c. ii) Who can be contacted during the day for further information?

Owner

Agent/Solicitor

2. LOCATION OF PROPERTY

Municipality

Civic Address (Street Number/Name)

Concession Number (if known)

Lot(s) Number(s)

Registered Plan Number:

Lot Number(s) (as identified on Registered Plan)

Reference Plan Number (if applicable)

Part(s) - separate multiple parts with a comma

Parcel(s) - (separate parcel numbers with a comma)

3. DESCRIPTION OF PROPERTY (as shown on Sketch)

You may upload a digital copy of your Sketch here:

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Frontage (m.)

Depth (m.)

Area (ha.)

4. USE OF PROPERTY

Official Plan Designation - Existing

Official Plan Designation - Proposed

Zoning By-law Designation - Existing

Zoning By-law Designation - Proposed

Uses of Property

Surrounding Land / Uses

Zoning of Adjacent Lands:

Existing Uses of Abutting Lands:

5. Other Planning Applications: Is the subject land, the subject of an application by the applicant for approval of an Official Plan Amendment, a Zoning By-law Amendment, a Minor Variance, A Plan of Subdivision, or Consent?

Yes

6. REQUIRED SCHEDULES AND ASSOCIATED INFORMATION

6. a. The following schedules must be submitted with your complete application: (please check boxes to confirm these schedules are included, either by file upload or by mailing them or bringing them to the Building and Planning department)

Site Plan

Elevation or Cross-Section Plan

Servicing and Drainage Plan

Landscape Plan

Dated at the

This Date:

Signature of Applicant, Solicitor or Agent

Clear

DECLARATION (This section must be completed in the presence of a Commissioner of Oaths at the Building and Planning Department, 30 Van Horne Ave., Dryden)

of the

In the County/District/Regional Municipality of

do 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 effects as if made under oath and by virtue of the Canada Evidence Act. If Planner's and/or legal fees are incurred by the City, pertaining to this Application, the Applicant, by endorsing below, hereby agrees to submit the balance due, upon receipt of an invoice for same.

DECLARED before me at the )

of in the )

of )

this day of , 20 ) Signature of Agent

Signature of Commissioner, etc.

AUTHORIZATION (to be completed ONLY if Property Owner is using an Agent or Solicitor)

i, We

hereby authorize

to make application on my/our behalf to the City of Dryden in connection with the property at:

Signed by: