Required fields are marked with asterisks (*)

Patio Permit Application Form

For any additional questions or concerns, please contact Development Services: 905-985-7346 or Planning@scugog.ca

Office Use Only - Date Received:

Owner Information

Registered Property Owner (Full Name):

Street Address:

City:

Postal Code:

Phone Number:

Email:

Applicant Information (required if Applicant is NOT the Owner)

Applicant Name/Company:

Applicant is:

Agent

Solicitor

Owner

Tenant/Business Owner

Contractor

Other

Mailing Address:

City:

Postal Code:

Phone Number:

Email:

Details of the Subject Lands

Municipal/Street Address:

Lot/Concession:

Assessment Roll No:

Business Name:

Summary of the Proposal:

Site Plan and supporting information Attached:

Yes

Alcohol and Gaming Comission of Ontario (AGCO)

Does the establishment have a current liquor license? *Note: if yes, this must be attached to make this a complete application.

Yes

Is this a New Patio Permit Application or Renewal

New Application ($250.00)

Renewal ($100.00)

How would you like to pay for this Application/Renewal?

In Person (Debit/Cash/Cheque)

Online (Debit/Credit Card)

Is this a New Liquor License Application/Permanent Extension or a Temporary Extension?

New Application/Permanent Extension ($358.21)

Temporary Extension ($83.00)

How would you like to pay for the AGCO Municipal Consent?

In Person (Debit/Cash/Cheque)

Online (Debit/Credit Card)

Owner Authorization

I/We:

Hereby authorize (Name of the person or company authorized to sign and submit this application)

To act as our agent to sign this application, to appear on my/our behalf at any hearing(s) in respect of the application, and to provide any information or material required by the Township in accordance with this application. I/We authorize the Township to collect such information from my/our client.

Signature(s) of Owner(s):

Clear

Dated:

Applicant Signature

By submitting this form, I agree to allow the Township of Scugog, its employees and agents to enter the subject property for the purpose of conducting visual surveys that may be necessary to process this request. I further agree to maintain all vegetation on site, including woodlots, and shall not cut or destroy any vegetation or re-grade the site during the processing of this request.

Owner/Authorized Agent (please print name):

Owner/Authorized Agent (signature)

Clear

Date:

Attachments

Please attach one (1) electronic copy of the proposed scaled Site Plan drawing. Please refer to submission requirements above for specifics.

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

If the establishment has a current liquor licence, please attach:

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