Application For A Notice For Proposed Development in a Vulnerable Area for a Municipal Drinking Water Source Fields marked with (*) are required Landowner Full Name (first and last)* Mailing Address* Postal Code* Phone Number* Alternate Phone Number Fax Number Email Agent/Applicant Same as Landowner Full Name (first and last)* Mailing Address* Postal Code* Phone Number* Alternate Phone Number Fax Number Email* What is your preferred method of contact?* Phone Email Type of Development/Works Proposed (check all that apply) * Building Permit Zoning Amendment Official Plan Amendment Consent/Severance Minor Variance Plan of Subdivision Other(please specify) Briefly describe what you propose to do (i.e. construct house or rezone for proposed commercial plaza)* Location and Other Details of the Proposed Development Street Address/911 #* Roll # Concession Lot Plan Municipality* Existing Use (select all that apply) * Residential Commercial Industrial Agriculture Other(please specify) Proposed Use (select all that apply) * Residential Commercial Industrial Agriculture Other(please specify) Select Yes or No for each item below that is, or may be, associated with the proposal Liquid fuel > 250L (includes home heating oil)* Yes No Automotive or manufacturing and processing related* Yes No Industrial strength cleaning agents* Yes No Application of septage (untreated liquids and solids from septic systems and holding tanks)* Yes No Petroleum refining waste; hazardous, liquid, industrial/commercial or municipal waste; mine tailings* Yes No Waste generated from medical, dental or veterinarian practice* Yes No Sanitary and/or storm, sewer systems and related pipes* Yes No Sewage system* Yes No Application, handling or storage of fertilizers, pesticides or agricultural source material (i.e. manure)* Yes No Application, handling or storage of non-agricultural source material (i.e. biosolids)* Yes No Grazing, pasturing or livestock confinement yard* Yes No Terms and Conditions Notices issued by Otonabee Conservation under Section 59 of the Clean Water Act are non-transferable. Permits, approvals, etc. may be required from other agencies prior to undertaking any activities that may be associated with this Application. The issuance of a Notice upon review of this Application does not exempt the owner/applicant from complying with any or all other applicable laws, statutes, ordinances, directives, regulations, approvals, etc. as they may relate to the activities carried out on the Property. If information on or with this Application is determined to be untrue or incorrect, Otonabee Conservation reserves the right to nullify any decisions and issuances based on the review of this Application. All non-personal information related to this Application becomes the property of Otonabee Conservation and may be used by Otonabee Conservation and its’ member municipalities. Members of the public may view studies, plans, reports and issuances related to this Application by submitting a formal request under the Municipal Freedom of Information Protection and Privacy Act, RSO 1990, c. M. 56. Access is subject to statutory exemptions.
