Applicant:
Permit to be issued to:
Address:
City:
Contact:
Telephone:
- Ext.
E-mail Address:
Regional Road Name:
Regional Road Number:
From Road:
To Road:
Nearest Intersection:
Date of Commencement:
Insurance Certificate Expiry Date:
A plan or sketch must be accompany this application, showing details and the location of the proposed works (must show nearest intersection).
A current certificate of liability insurance in the amount of at least $1,000,000 to $10,000,000 naming the Region as an additional named insured. This certificate must accompany the application. The amount will be specified by the Region.
Conditions:
Verify your submission by typing the 6-digits you see in the box:
Verify Code * Required Can't read it? Try a Different Code
If you have any questions regarding this form, or need help completing it, please contact the Region at 905-685-1571 ext.3267 or ext. 3263
Forms, Permits, Fees