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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:

review the requirements and fees on the Committee of Adjustment web page
check to see if source water protection applies to the subject land
download the source water protection document from the Region of Waterloo source map if required
download and complete the environmental screening questionnaire
be aware that the total size of all documents uploaded to this form cannot exceed 15 MB

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.

Date you are submitting the application

Have you consulted with a staff member before starting this application?

Yes

Confirm that you have considered the following before continuing this application. Submit relevant documentation with this application if it applies.

Impacts to grading and drainage of the property

Measures to reduce carbon emissions

Impact of removal of trees

Whether you require a heritage impact assessment or heritage permit

Section 1: Applicant information

Provide your contact information as the applicant

Applicant full name

Applicant email address

Applicant phone number

Applicant street address

Applicant city

Applicant postal code

Name of owner or owners of subject lands as identified on the deed or title.

Identify your role for this application.

Owner of subject lands

Agent representing the owner

Authorized person representing a corporation

Owner email address

Section 2 - Subject land details

Street address

Postal code

Legal description

Lot no/Part no

Registered plan number

Reference plan number

Zoning

Official Plan designation

Lot frontage (in metres)

Lot depth (in metres)

Lot area (in metres squared)

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

Yes

Date of purchase

Add another property Remove the property

Has the land previously been the subject of an application for minor variance, consent or a plan of subdivision?

Yes

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?

Yes

Section 3 - Information about the consent requested

Type of consent required

severance of land

right of way

easement

lease

lot addition

title correction

charge

other

Briefly describe the type of proposal and the purpose including the existing and proposed uses for the land

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

Yes

Section 4 - About the proposed severance and uses

Will the property be severed? (includes for lease or easement)

Yes

Provide details of all EXISTING buildings and structures on the severed land including uses and dates of construction.

Provide details of all PROPOSED buildings and structures on the severed land including uses and dates of construction.

Provide details of all EXISTING buildings and structures on the retained land including uses and dates of construction.

Provide details of all PROPOSED buildings and structures on the retained land including uses and dates of construction.

Provide details about the road access for each parcel. Include the type of road and road name for each proposed parcel.

What is the current water supply for the subject land?

Municipal water service

Well water service

Other

What is the proposed water supply for the subject land?

Municipal water service

Well water service

Other

How are current sanitary services provided for the subject land?

Municipal sanitary service

Septic sanitary service

Other

How are sanitary services proposed to be provided for the subject land?

Municipal sanitary service

Septic sanitary service

Other

Section 5: Describe uses and features of the subject lands

Are any of the following on the subject land?

An agricultural operation, including livestock facility or stockyard

A landfill site

A sewage treatment plant or water

Stabilization plant

A provincially significant wetland

Floodplain

A contaminated site

An active railway

An industrial or commercial use (for example an office building or retail store)

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

An agricultural operation, including livestock facility or stockyard

A landfill site

A sewage treatment plant or water

Stabilization plant

A provincially significant wetland

Floodplain

A contaminated site

An active railway

An industrial or commercial use (for example an office building or retail store)

Section 6 - Upload documents to support the application

The total size of all documents uploaded to this form cannot exceed 15 MB.

Provide the following documents for each application:

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.
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
The environmental screening questionnaire
The water source protection screening form
The Notice of Source Protection Plan document (if relevant)
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.

Upload the required application documents. Up to 10 documents can be uploaded. The maximum size of each document is 10MB.

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Section 7 - Acknowledgements

Check the boxes and sign below for the following acknowledgements

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. If I am not the owner, the consent letter is uploaded in Section 8.

I consent that all information and documents provided as part of this application may be used by the City at any time and retained by the City for the purposes of evaluating and processing proposals/applications, made available for public review, reproduced for any municipal purpose, posted on the City's electronic media including its webpage, and used in City agendas and other forms of communication including reports and presentations. For the purpose of the foregoing, the City means The Corporation of the City of Waterloo and where the context so implies includes its council, employees, officers, agents, solicitors and consultants.

I understand that receipt of this application by the City of Waterloo does not guarantee it to be a “complete” application. Further review of this application will be undertaken and I may be contacted to provide additional information and/or to resolve any discrepancies, issues or insufficient information with the application as submitted. Once the application is deemed to be complete, the application fee will be deposited and the application will be processed.

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.

Upload the owner consent document if the applicant is not the sole owner

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Draw your signature showing your acknowledgement of the statements in sections 7 and 8 or upload an image of your signature below.

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Upload an image of a signature

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Signed date

Form Builder

Committee of Adjustment Application for Consent

Section 1: Applicant information

Section 2 - Subject land details

Section 3 - Information about the consent requested

Section 4 - About the proposed severance and uses

Section 5: Describe uses and features of the subject lands

Section 6 - Upload documents to support the application

Section 7 - Acknowledgements

Section 8 - Owner consent