Application for Municipal Consent/Location Approval Certificate for By-law #69-22

6648 Road 506, Plevna, Ontario K0H 2M0

Tel: (613) 479-2231 or 1-800-234-3953, Fax: (613) 479-2352

www.northfrontenac.com

GENERAL

Contact Information

Provide the contact information for the party requesting Municipal Consent (MC) on behalf of the Proponent.

Project Description

Enter Yes or No for each of the items below for the proposed work within the Right Of Way (ROW)

Work Location

Provide a sketch of the location of the work, including lots, roads, the locations of the buildings and the location of the construction/work zone.

Submission Requirements

 A complete Municipal Consent Application requires submission of:

• This completed application from;
• The Drawings completed in accordance with the requirements stated, and
• Confirmation of all other required approvals from other agencies.

Permit Details

1. The Proponent must agree to the terms for Liability Insurance as stated by the Township.

2. All works must be carried out in compliance with the Occupational Health and Safety Act and adhere to the rules and regulations as set out in the Ontario Traffic Manual Book 7. The applicant supplies all signs, flashers, barricades, devices and traffic control persons required to close lanes and manage traffic around the immediate work area.

3. All excess material must be removed off-site at the expense of the permit holder.

4. All minimum horizontal and vertical clearances to existing facilities should be maintained in accordance with published specifications. Stated clearances may be reduced with the written permission of the affected facilities owner(s).

5. Prior to the Township issuing a permit the Proponent must confirm they have all required approvals and permits from others.

6. Notice must be provided and approval must be obtained from the Township prior to closing or restricting any road at any time for short duration work (or longer), except under emergency circumstances. The hours of work for closing or restricting any road at any time will be at the discretion of the Township.

7. The Proponent must obtain stakeouts from all Owners of underground plant and comply with any instructions from the plant Owners when working in proximity to their plant. All existing plant must be protected, supported, backfilled and compacted to the satisfaction of the plant owner.

8. The Proponent shall adhere to all required backfill and restoration requirements.

9. The Successful Proponent guarantees and warrants that with ordinary wear and tear the said work shall, for a period of twenty-four (24) months from the date of completion, remain in such condition and will meet with the approval of the Township and that they will make good in a manner satisfactory to the Township any imperfections therein due to materials used in the construction of or workmanship.

10. Upon notification by the Township, the Proponent shall address any deficiency that develops at or as a result of the utility installation that impacts the operation and or maintenance of the Township road(s). Examples include settlements, bumps, drainage or erosion issues, reduced vertical clearance, trees resting on aerial installations or trees leaning towards the road that cannot be felled due to the utility etc. The Township reserves the right to do any remedial or restoration work that in the opinion of the Township has not been adequately performed by the Proponent. The Township will invoice the Proponent for the cost of such remedial or restoration work.

11. No open cutting of the roadway will be allowed from November 1^st to May 15^th unless approved specifically by the Township.

TO BE FILLED OUT BY THE TOWNSHIP

RETURNED BY THE TOWNSHIP

The Township has received and reviewed the Application for a Location Approval Certificate