Required fields are marked with asterisks (*)

ROADWAY OCCUPATION PERMIT APPLICATION

“Note: Due to the increase volume in permit application to the District, please expect an initial response within 4-6 weeks of submitting your application. For inquiries regarding the status of your permit, please contact roads.permits@muskoka.on.ca”

Applicant Name:

Address:

Postal Code:

Phone:

E-Mail:

Contractor Name:

Address:

Postal Code:

Phone:

E-Mail:

Muskoka Road Number & Work Location:

Description of Project (sketch must be provided):

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Are Other Approvals Required:

If yes, who:

Work Will Commence:

Be Completed:

Traffic Lanes Will Be: Maintained

Partially Closed

Closed & Detoured (provide detour routing map):

Where Muskoka Roads are crossed, they will be by: Directional Bore

or Open Cut

Where Sideroads & Entrances are crossed, they will be: Directional Bore

Open Cut

Other

THE APPLICANT HEREWITH WARRANTS THAT ALL WORKMANSHIP AND MATERIALS PLACED UNDER THIS APPROVAL SHALL BE MAINTAINED AND GUARANTEED FOR A PERIOD OF TWO (2) YEARS FROM THE DATE OF COMPLETION OF TEMPORARY RESTORATION OR ONE (1) YEAR FROM COMPLETION OF PERMANENT RESTORATION, WHICHEVER IS LONGER. THE APPLICANT AND THE CONTRACTOR HAVE READ AND WILL CONFORM TO THE METHODS OF INSTALLATION AND RESTORATION AS OUTLINED IN THE DISTRICT'S "PROCEDURES AND INFORMATION REGARDING ROADWAY OCCUPATION" BOOKLET. PERMITEE SHALL GIVE 48 HRS. NOTIFICATION TO THE DISTRICT BEFORE COMMENCEMENT OF THE AUTHORIZED WORKS.

Date:

Signature:

Clear

Title:

Municipal Approval Section

Muskoka Permit No.:

On the basis of this application and all pertinent schedules and by-laws and nothwithstanding any other liability, approval regulation, by-law, or provincial statute, the applicant is herewith approved to proceed with the road occupation as requested. Restoration shall be in accordance with a class "D" procedure as detailed in the "Procedures and Information Regarding Roadway Occupation" booklet.

This Permit is issued under the authority vested in the District Municipality of Muskoka by the Public Transportation and Highway Improvement Act and the Regulations pursuant thereto and is subject to the conditions of the back hereof, and to the conditions of any special agreement applicable to the Roadway Occupation authorized by this Permit.

Comments:

Release of Liability Form Issued: Yes

Licence of Occupation Required: Yes

Date:

Signature:

Clear

Road Section No:

Personal Information on this form is collected by The District Municipality of Muskoka under the authority of The Municipal Act, 2001, S.O. 2001, c25, as amended and by by-laws passed pursuant to it and for the purpose of an Application & Permit for The District of Muskoka Roadway Occupation and for no other purpose. Applicants are advised that Muskoka may be required to disclose information in this form under the Municipal Freedom of Information and Protection of Privacy Act. Questions should be directed to the Freedom of Information Coordinator, 70 Pine Street, Bracebridge, ON, P1L 1N3

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ROADWAY OCCUPATION PERMIT APPLICATION