Required fields are marked with asterisks (*)

Letter of Authorization

This form should be completed to appoint an authorized agent for your project, such as a contractor or tenant.

Please be sure to complete all required applications/forms for your project.

Project Description (select all that apply)

Building Permit

Entrance Permit

Plumbing Permit

Pool Permit

Septic Permit

Sign Permit

Community Improvement Plan (CIP) application

Address of Subject Property (if applicable)

Please describe the proposed project

Owner Information

First Name (Owner 1)

Last Name (Owner 1)

Is there more than one owner for the property?

Yes

Address

Town

Postal Code

Phone number (10 digits separated by dashes)

Email:

Agent Information

Authorized Agent First Name

Authorized Agent Last Name

Address

Town

Postal Code

Phone number (10 digits separated by dashes)

Email:

I/We the undersigned, as registered property owner(s) of the above noted property, authorize the agent named above to submit, amend and execute a (same as above selections) on our behalf for the purposes of this application(same as above selections).

I/We understand that we are ultimately responsible for ensuring that the project is completed in accordance with Applicable Law, Municipal By-law and the Building Code, as amended.

Furthermore, for the purposes of the Freedom of Information Act, I/We authorize and consent to the disclosure of any information that is collected under the Building Code Act and the Building Code, as amended, to required agencies or the purposes of processing this application.

I/We hereby certify the above information submitted in this application is true and accurate to the best of my/our knowledge.

Please provide signature

Clear

Notice of Collection: Personal information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act, and will be used for the purpose of processing the request to appoint an Authorized Agent. Enquiries regarding the collection of this information may be directed to the Office of the Clerk/Freedom of Information Coordinator, Municipality of Trent Hills, 66 Front Street South, Campbellford, ON K0L 1L0 705-653-1900

Land Acknowledgement

We recognize the traditional keepers of this land and, specifically our neighbours of the Alderville First Nation, with a formal territorial acknowledgement.

Welcome to the Gunshot Treaty Lands of 1788. It is on these lands and on the shores of the big lake, the Mississauga Anishinabeg met with the Crown to facilitate the opening of these lands for
settlement.

Let us be reminded of the responsibility we all have in making sure that we respect these lands and waters that give us life and sustain our livelihoods.