Please complete this form if you would like to submit and pay for your Entrance Permit Application.
Required fields are marked with an asterisk(*).
Please be advised that a service charge of 2.9% is applied by the service provider Bambora to cover processing costs for payments made using credit cards.
PLEASE NOTE: In an effort to expedite the approval process, applicants are required to stake-out their proposed entrance upon submission of this application so that staff can visually see the proposed entrance.
PROPERTY OWNER INFORMATION
AGENT/BUILDER INFORMATION
LOCATION OF PROPOSED ENTRANCE
Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif
PURPOSE AND DIMENSIONS
SIGHT DISTANCE
(Approximate distance that approaching traffic is visible from the point of entrance to the Township Road)
APPLICANT/OWNER
It is understood that:
In consideration of any permit issued in respect of this application, we, the applicants for ourselves, our heirs, executors, successors and assigns hereby agree to observe, keep and perform and be subject to the regulations and conditions of the said permit, and to indemnify and save harmless the Township of Essa (represented by the Manager of Public Works or his/her designate) from and against all loss, cost, charges, damages, claims and demands whatsoever to which it may be put or which the Township of Essa suffers or sustains or for which the Townshipof Essa may be liable by reason of anything done or omitted to be done in the construction, maintenance, alteration or operation of the works authorized.
Personal information contained in this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), and will be used only for the purpose for which its collection was intended. Questions about this collection should be directed to the FOI Coordinator at the Township of Essa.