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APPLICATION FOR DEVELOPMENT, INTERFERENCE WITH WETLANDS AND
ALTERATIONS TO SHORELINES AND WATERCOURSES
(Pursuant to Ontario Regulation 160/06)
PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS FOR SUBMITTING PLANS
Owner’s Name/Organization _________________________________________________
Mailing Address __________________________ City/Town _______________________
Postal Code __________ Email____________________________ Phone # ____________
Agents Name ___________________________ Email ___________________________
Organization ____________________________ City/Town _______________________
Mailing Address _____________________ Postal Code ________ Phone # ____________
Municipal Street Address ___________________________________________________
L
ot _______ Concession/Range ___________ City/Town__________________________
If the property is used for agricultural purposes does it have a biosecurity protocol?
Yes
No
The proposed development(s)/work(s) involve(s) the following (select all that apply):
New structure
Alteration/addition to existing structure
Grading/site alteration
Alter a watercourse
Interference with a Wetland
Lake Ontario shoreline works
Proposed works: _________________________________________________________
______________________________________________________________________
______________________________________________________________________
1255 Old Derry Road
Mississauga, ON L5N 6R4
Tel: (905) 670-1615 or 1-800-668-5557
Fax: (905) 670-2210
www.cvc.ca
e-mail: planning@cvc.ca
Property Location
il
Ownership Details
Description of Type of Development / Work Proposed
For office use only:
File # ____________________
Fee Received _____________
.
Have you conducted any pre-development consultation with Planning and Development Services
Staff at CVC to determine site characteristics and technical requirements for a complete
application? (A pre-development consultation may be in the form of a phone conversation, a
meeting, email messages or site visit).
Yes (indicate method below)
No
phone
meeting
email
site visit
other way
Were you provided with an application checklist?
Yes
No
Were you provided with a File Number?
Yes (please specify) ______________
No
1. Any false or misleading statement made on this application will render null and void any
permission granted.
2. Authorized representatives of Credit Valley Conservation are granted entry in accordance with
the Conservation Authorities Act, R.S.O. 1990, c27 as amended onto lands which are the
subject of this permit application in order to make such surveys, investigations, inspections or
other arrangements which such representatives deem necessary.
3. This permit does not absolve the applicant of the responsibility of obtaining all the necessary
permission(s) from applicable federal and provincial agencies or local municipalities.
I, ___________________________ solemnly declare that to the best of my knowledge and
belief, all of the above information to be true.
Signature of Owner: ________________________ Date: ____________________
Note: Signature or written authorization from the owner is mandatory.
Signature of Agent: _________________________ Date: ____________________
INSTRUCTIONS
Please submit three (3) copies of the following information with this application:
1. Location map of property, in relation to surrounding buildings, roads, lands etc.
2. Site plan indicating the property boundary and the proposed location of development/work.
3. Cross-section(s) of the proposed development/work showing existing and final grades as
required.
4. Final stamped engineering drawings of proposed development/work as required.
5. Final stamped technical reports in support of proposal as required.
6. Other documentation as identified through pre-consultation.
7. An application fee will be charged based upon type and scale of project (see most
recent fee schedule www.cvc.ca or contact CVC office at 905-670-1615).
ALL PLANS SUBMITTED MUST BE FOLDED
Terms and Conditions
NOTICE OF COLLECTION
Pursuant to the Municipal Freedom of Information and Protection of Individual Privacy Act, the personal information
contained on this form is collected under the legal authority of the Conservation Authorities Act, R.S.O. 1990, c27 as amended
.
This information is used to assess applications and, where approved, issue the Permit. Information on this form may be
disclosed to Government and Municipal Agencies for review and comment and to members of the public through the Freedom
of Information process. The name of the a
pplicant, location of the work and a description of the project may be published in
CVC documents including agendas, reports and meeting minutes which are posted on CVC’s website. Questions about the
collection of personal information should be directed to the Freedom of Information Coordinator, Credit Valley Conservation
Authority, 1255 Old Derry Road, Mississauga, Ontario, L5N 6R4, (905) 670-1615.
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