Instructions: Check Area(s) applied for
( ) New Development / Building ( ) Addition ( ) Mobile Home
( ) Change the Location of Building or Structure ( ) Change the Use of Building

1. Applicant Information: Applicants Name: ................................................................................

Mailing Address: ......................................................................... Postal Code:...........................

(H) phone ................. (W) phone ................. Fax ................ Email ............................................

2. Property Information: Property Owners Name: ........................................................................

Property Tax No. ................... Subdivision Lot No. (if applicable) ...........................................

Community Name: ........................................ Road Name ..........................................................

Civic Address: ............................................... Existing use of the land .......................................

Size of Property being developed : Road Frontage Width :................... Depth ........................

3. Highway Access Driveway: Will the development require the creation of a new highway access driveway or the relocation of an existing access driveway? ( )Yes ( ) No

4. Development / Building Permit Information:

If existing, what is the present use of the building: ...................................................n/a ( )

The proposed use of the new ( ) or existing structure ( ) is:

Residential: ( ) single family ( ) duplex ( ) multiple ( ) mini home ( ) mobile home

( ) summer cottage ( ) rental cottage ( ) agriculture ( ) commercial ( ) industrial

( ) institutional ( ) non-commercial garage ( ) non-commercial storage building

( ) storage building ( ) travel trailer ( ) other, please describe ............................................

If an addition, what is the purpose ........................ ........ ................................................. n/a ( )

5. Size of Building, Structure or Addition: No.of stories: ............... No. of bedrooms ..........

Main Building: (if applicable) 1st Floor .......... ft. x .......... ft. = .......... sq. ft. 2nd Floor .......... ft. x .......... ft. = .......... sq. ft. Accessory Building: (if applicable) ..........ft. x .......... ft. = ............... sq. ft.

Addition: (if applicable) 1st Floor ........ft. x ........ ft.= .........sq.ft. 2nd Floor ........ft. x ........ ft. = .........sq.ft. Structure: (if applicable) .......... ft. x .......... = .............. sq.ft.

Total square footage of main building and / or addition ................... sq.ft.

Total square footage of all structures proposed for the site ................ sq. ft.

Type of foundation .....................exterior wall finish ..................... Roof material .................

6. Location of the structure, building or addition:

(a) distance to the center of the nearest road, street or right-of-way ? ...................................ft.

(b) distance to the nearest property boundary?........................................................................ ft.

(c) Is there a watercourse, wetland, saltwater body or dune system on or near the proposed development? ( ) yes ( ) no

If yes, indicate the distance to the nearest feature .............

7. Mobile Home Application Only: Factory built: YES ( ) NO ( ) Model name:................................. Age of home: ..............

Size of home: Length ...............ft Width ..................ft No. of bedrooms .....................

8. Type of Servicing:

(a) Do you plan to construct or upgrade a sewage disposal system ? ( ) Yes ( ) No

If No, please explain .................................................................................................................

(b) Do you plan to construct an on-site well? ( ) Yes ( ) No

If No, please explain ........................................ .........................................................................

(c) Will there be underground fuel storage? (Other than oil tank in basement) ( )Yes ( )No

9. Estimated Cost of the Project: ......................................................................................

Start time ...............Finish construction ...................

10. Draw a Sketch in the Space provided below showing:

(1) Dimension of the lot;

(2) Location of the proposed or existing structure on the lot ( show the distance from the road (right of way) boundary and the nearest side property boundary);

(3) General slope of the land (indicate with arrows);

(4) Location of septic tank and absorption field (show the distance from the house , well, property boundary and bodies of water);

(5) location of well (show setback from the nearest portion of the sewage disposal system);

(6) Distance of the center of driveway from side property line.

(7) Distance of the proposed building or addition from nearest watercourse, wetland, sand dune or saltwater body.

I hereby certify that to the best of my knowledge and ability, the information that I have provided on this form is true and complete.

11. Applicant’s signature ........................................................................................ Date........ ........................

Note: The application along with the application fee should be forwarded to the above address. For further information and / or assistance, please drop into the community office (Eastern Kings Fire Hall (Tuesday morning) or phone the community office.

The applicant is advised that the issuance of a Development Permit does not imply any obligation on the part of the municipality to classify or maintain roads adjacent to the property upon which the authorized building will be constructed or to a classification or a standard higher than the classification or standard in force at the time of the issuance of the permit, or to provide any service not provided on the date of this application.

Municipality Use Only : Development Permit No. ........... Date Application Received .................. Fees Paid .......