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Committee of Adjustment Application for Consent

Request a severance, right of way, easement or lease using this application.

Before you start: 

Notice of Public Record
All information and materials required in support of your application shall be made available to the public, as indicated by Section 1.0.1 of the Planning Act, R.S.O. 1990, c. P.13 as amended.

Municipal Freedom of Information and Protection of Privacy Act
Personal information on this form is collected under the authority of the Planning Act and will be used to process this application and may be publically disclosed.

Questions about this collection may be directed to the Commissioner of Integrated Planning and Public Works, Waterloo City Centre, 100 Regina Street South, P.O. Box 337, Station Waterloo, Waterloo, ON N2J 4A8. Telephone 519-747-8752.

Have you consulted with a staff member before starting this application?
Confirm that you have considered the following before continuing this application. Submit relevant documentation with this application if it applies.

Section 1: Applicant information

Provide your contact information as the applicant

Identify your role for this application.

Section 2 - Subject land details

Are there any easements and/or restrictive covenants affecting the subject lands?

Has the land previously been the subject of an application for minor variance, consent or a plan of subdivision?
Is the subject land currently the subject of any other application under the Planning Act including a proposed regional or local Official Plan Amendment, a Zoning Bylaw Amendment, minor variance or draft plan of subdivision?

Section 3 - Information about the consent requested

Type of consent required
Does this proposal require a minor variance application (a minor change to the zoning to permit intended use)?

Section 4 - About the proposed severance and uses

Will the property be severed? (includes for lease or easement)
What is the current water supply for the subject land?
What is the proposed water supply for the subject land?
How are current sanitary services provided for the subject land?
How are sanitary services proposed to be provided for the subject land?
How is storm drainage accommodated on the subject lands?
How is storm drainage proposed to be accommodated on the subject lands?

Section 5: Describe uses and features of the subject lands

Are any of the following on the subject land?
Are any of the following within 500 metres of the subject land?

Section 6 - Upload documents to support the application

Provide the following documents for each application:

  1. If the applicant is the purchaser or the purchaser's agent, a copy of the portion of the agreement of purchase and sale that authorizes the purchaser to make the application in respect of the land that is the subject of the application.
  2. A sketch showing the following:
    • project name
    • applicant name
    • name of the firm preparing the plans (if applicable)
    • dimensions provided in metric 
    • scale of the drawing
    • north symbol
    • municipal address
    • names of adjacent streets
  3. The environmental screening questionnaire
  4. The water source protection screening form
  5. The Notice of Source Protection Plan document (if relevant)
  6. Any other documents identified as required during a pre-application consultation with city staff

View the web page for more information about the documents required.



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Section 7 - Acknowledgements

Check the boxes and sign below for the following acknowledgements

Section 8 - Owner consent

Authorization from the owner of the property is required to apply for a consent application. If you are not the sole property owner, a letter of authorization from the property owner(s) including their contact information and signature must be attached to this application. Unless otherwise noted, all communications will be sent to the agent or tenant if the applicant is not the property owner. 

Consent must include the following text: I hereby authorize the City of Waterloo and each of its directors, officers, employees, solicitors and agents to enter onto the above noted property(ies) for the purpose of evaluating the merits of this/these application(s) or request(s) over the time this/these application(s) or request(s) is/are under consideration by the City of Waterloo.



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


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