Kettle Creek Conservation Authority
Name of Landowner:
Mailing Address:
City:
Postal Code:
Tel. Home:
Tel. Other:
Email:
if an Agent is authorized on behalf of the Landowner, complete the following:
Name of Agent:
Organization:
Tel. Bus:
Property Location: (Street and Number (911) or Lot and Concession or Lot and Plan)
Municipality: Community:
Project Description:
List attachments (Details of Drawings, Plans, Reports etc,…):
Existing use of land:
Proposed use of Land:
Proposed Start Date:
Completion Date:
Are Planning Act or Municipal Approvals required? (eg. Zoning, Severance, Building Permits, etc…) NoYes
If yes, provide details:
(limit of 1GB upload)
Review Submission Requirements
I have read and understand the submission requirements. (required)
Review Terms & Conditions
I have read and understand the terms and conditions. (required)
I/we acknowledge that it is our responsibility to ensure that a valid KCCA permission is in effect at the time the works are undertaken.
I/we agree to allow representatives of the Kettle Creek Conservation Authority and other persons as required by KCCA, to access the property for the purpose of obtaining information relevant to this application.
I/we further agree to undertake or obtain, at my own expense, further information, studies, reports, etc… prepared by others, if such is required by the Conservation Authority to properly review the application.
I/we the applicants, agree to indemnify and save harmless the Kettle Creek Conservation Authority and its officers, employees, or agents from and against all damages, loss, costs, claims, demands, actions and proceedings, arising out of or resulting from any act or omission of the Owner and/or Applicant or any of their agents, employees or contractors relating to any particulars, terms or conditions of permission granted by the Conservation Authority.
Please sign your name below:
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