Proponent/Owner/Other Information

Name of Proponent/Owner:

Mailing Address:

Street Address (if different from above):

City:

Province:

Postal Code:

Telephone: (home)

Telephone: (work)

Telephone: (other)

Fax::

Email Address:

Name of Contractor/Agent/Consultant (if applicable):

Mailing Address:

City:

Province:

Postal Code:

Telephone:

Telephone (work):

Telephone (other):

Fax::

Email Address:

Project Location Information

Name of Nearest Community to Project:

Municipality:

Legal Description: (Lot, Concession, Parcel No., Lot, Plan No. or Ref. Plan)

Name of Watercourse (river, creek, lake):

Description of Project: (Please attach additional information & sketches)

What is the proposed project?  (Building or structure, dock, dam, bridge, retaining wall, filling, altering, interfering with, straightening or diverting waterway, etc.)

Proposed Start Date:

Proposed Completion Date:

Status of the Project (circle one):
New
Existing
Addition
Repair

Is the work permanent or temporary?

Description of shoreline if applicable (i.e. ground type, vegetation, slope, other) Enclose photographs 

Is fill to be placed?  Indicate type of fill and quantity.

Description of watercourse bottom

 (i.e. sand, rock, mud, weed other)

Will you be working in the water? Yes No

What to Include with your application:

$            A detailed project description and rationale

$            A map or chart to show location of project

$            A sketch or drawing of your project, including side and top view and showing dimensions of the work

$            A survey plan or sketch with dimensions indicating the location of existing buildings, shoreline structures, property lines, etc.

$            Current photographs of the work site displaying elevation or slopes, shoreline, shoreline vegetation if applicable

$            Appropriate fee for this application (contact office for Fee Schedule)

Date:

Signature: _____________________

By signing this form, I hereby give representatives of the N.D.C.A. permission to enter upon my property for the purposes of inspection with regard to this application and the proposed construction project.