Municipal Consent Application

Prior to the approval of the municipal consent application, the applicant will be subject to pay all fees in accordance with the most current user fee by-law. It is understood that all works will be constructed, altered, maintained, or operated at the expense of the undersigned and that work must not being before an application has been issued by the County. The applicant is responsible for obtaining all other approvals and permissions from various authorities having jurisdiction within the proposed work location. The applicant agrees and accepts full responsibility for the protection of all utilities, private property and persons affected by his/her operations and further indemnify and save harmless Dufferin County and all assets and personnel it is in law responsible for. I/We the undersigned have read and understood the information provided and agree to abide by all conditions as they may apply to the approved permit.

I/We the undersigned have read and understood the general conditions lusted below and agree to abide by all conditions as they may apply. NOTE: the County may add additional conditions as determined by the County. 1. Municipal Consent Application is subject to all Municipal and County By-Laws. 2. A Road Occupancy Permit will be required prior to construction, and shall be obtained from the County prior to mobilizing within the County's Right-Of-Way (ROW). 3. Municipal Consent (MC) will only be valid for a period of 6 months from the date of issuance. If further time is required, a new MC or extension of the old MC is required. 4. Any modification of the approved design must be reviewed and approved by the County through an addendum to the original MC application. 5. This application must not be assigned or transferred from one applicant to another. Each new application is subject to the conditions applying at the time of issuance. 6. Municipal Consent may be cancelled at any time for breach of the regulations or conditions of the application of for such reasons as the County in its discretion deems appropriate. 7. The County may require the applicant to enter into a Municipal Access Agreement when continual operation of future maintenance may be required for the new utility. 8. Municipal Consent granted by the County does not constitute confirmation of any other utilities that may be encountered during construction. It is the SOLE responsibility of the application to the confirm the location of all such utilities with the applicable service provider. 9. The applicant shall indemnify and save harmless the County of Dufferin and its respective officers and agents against all claims, demands, losses, costs, damages, actions, suits or proceedings by whomsoever made, brought, or prosecuted in any manner based upon, arising out of, related to, occasioned by or attributable to the activities or omissions of the applicant.

Payment in full must be made prior to any service commencing, or permits being issued. All returned payments will be subject to a $20.00 NSF fee.

The information collected on this form is for the administrative and issuance of Municipal Consent. The information is collected under the authority of the Municipal Act. Questions regarding the collection of this information can be directed to the Director of Public Works/County Engineer at 519-941-2816 ext. 2600.