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Public Works Permit Application

Permit Type:

Right of Way (Road use/Road cut)

Entrance

Sanitary Sewer Connection

Storm Water Connection

Water Service Connection

Description of Proposed Work:

General Information

All areas of this section must be complete
Required telephone numbers should be the preferred contact
The application will not be reviewed until a complete application is received

Name:

Mailing Address:

City:

Postal Code:

Phone Number:

Email:

Today's Date:

Signature:

Clear

Is the Contractor the Same as Owner/Applicant?

Yes

A certificate of insurance is required listing the County of Brant as an Additional Insured. Please attach the certificate of insurance here:

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Work Location

All areas of this section must be complete
Attach a Site Plan or sketch indicating location of the work area. (Example: new builds require stamped engineers site plan, entrance repave requires simple sketch of entrance width in road allowance)

Municipal Number: (Street Address, e.g. 5 Apple Street)

Please describe the work location:

Property Use:

Residential

Commercial

Industrial

Agricultural

Institutional

Other

If other, please explain here:

Have you applied for a Building Permit?

Yes

Is the Property Subject to a Planning Application/Approval with the County?

Yes

Site Plan Accepted by the County:

Yes

If a Site Plan is not attached, please provide a detailed sketch and attach to this application

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519.44BRANT (519.442.7268) 1.855.44BRANT

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