Required fields are marked with asterisks (*)

Site Alteration Permit

Please ensure all fields of the form are completed accurately.

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Purpose

To pay for Site Alteration Permit by Debit Visa or credit card. If you have any questions regarding this form, please contact Revenue Division

Notice of Collection

Personal information contained on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c. 25 and will be used for the purposes of administering your request. Questions about this collection should be directed to the Supervisor of Information Services.

Applicant Name

Location of proposed work

Application Number:

Payment Information

Full Name of Payer

Amount to be paid

Address

Town

Postal Code

Phone #

Work Location (if different than address above)