Application for Entranceway and Civic (911) Numbering

Name (of landowner):

Name (of applicant):

Address:

City/Town:

Postal code:

Country

Phone:

Is a civic number required?

Yes

Location

Lot #:

Con. #:

Roll #:

Township road:

Side of road:

Between civic number:

and:

Specifically: metres

North

South

East

West

of:

Purpose of Application

Alteration or change in use of existing entranceway

Permanent entranceway

Classification of Entranceway

Commercial

Agricultural to farm

Residential

Payment in the amount of $100.00 (entranceway) and/or $75.00 (civic) (refundable should the application be denied) shall accompany this application.

I/We hereby apply to the Corporation of the Township of North Dundas for permission to construct an entranceway described above and to hereby agree to conform to the Township's terms and conditions, standards and specifications governing entranceways.

Terms and conditions of permit for entranceway

View terms and conditions (PDF)

Date:

Signature:

Sign above

For Office Use Only

Civic number assigned: #

Date fee collected

$100.00 Entrance:

$75.00 Civic number:

Permission Granted and Approved Specifications

Entranceway Dimensions

Width of entranceway at ditch/curbine:

If a pipe is required, the pipe shall be new galvanized steel or plastic SP nominal thickness:

Pipe length: metres

Pipe diameter: mm

Upon submission of your completed form, please call the Township of North Dundas at 613-774-2105 to process payment, or visit us in person at 636 St. Lawrence Street, Winchester, Ontario K0C 2K0.

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