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APPLICATION FOR AN ACCESS PERMIT/ENTRANCE CULVERT

(IN ACCORDANCE WITH BY-LAW #98-50)

Property Desciption

By signing below, I hereby unequivocally agree and acknowledge that the Corporation of the City of Quinte West is in no way responsible for any damages to persons or property arising out of the above work and hereby undertake to save harmless and indemnify the Corporation and its employees, agents, boards, officers, directors etc. from all suits, claims, demands, actions, damages etc., whether same shall be with or without merit and from all costs to which the City may be put in defending such action, claim or demand in any way arising out of, or alleged to arise out of any work, service, operation or thing constructed, installed, maintained or done or omitted to be done by the City relative to this permit.

Please Note: All associated costs with this access application, i.e. surveying, engineering, legal costs, et cetera, are the responsibility of the applicant. All submissions will be treated as public records and disclosed to the public and/or media upon request.

I have read and therefore acknowledge and agree to all of my obligations as outlined in the “Guidelines for the installation of entrance culvert”. THEREFORE, I hereby request an entrance culvert and declare that the statements made3 in this application (and any information in any accompanying maps/drawings) are true and in accordance with the Guidelines and the City of Quinte West By-Law #98-50 as amended from time to time. I understand that all associated costs with this culvert installation are my responsibility.

The location of the new access will be staked by the applicant as shown below. (The location of the access must be measured from a known control point, fenced survey lot line, survey monument shown on a registered plan, et cetera.)

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