Required fields are marked with asterisks (*)

Drain Layer Licence Application Form

The Township requires that complete applications are submitted a minimum of fifteen (15) business days before the anticipated start of work. Please note that documentation is required for all licensees and that completion of this application form does not guarantee final approval of a licence.

Only one application is required per organization, but documentation of a trade licence or proof of successfully passed examination must be submitted for all persons to be licensed.

Please review the Township's Licensing By-law and Fees and Charges By-law before proceeding with the application as each provides additional information about licensing requirements and fees.

Payment may be submitted:

Online - online with a credit card, please note that there is a $2.75 convenience fee that is collected and paid to Paymentus for using the online payment system.
In-Person - payment can be completed in-person at the Township Adminstration Office, 24 Church Street West, Elmira between the hours of 8:30AM to 4:30PM Monday to Friday.

Name of Primary Contact:

Name of Business/Organization:

Primary Contact Telephone Number:

Primary Contact Email Address:

Mailing Address (Street Number, Street Name, City/Town, Postal Code):

Please provide the names of all Drain Layers to be licensed.

Please provide a current certificate of general liability insurance with a minimum coverage of $2,000,000.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx,

The undersigned hereby applies for a licence as described, and agrees to comply with all municipal by-laws and regulations and all other application requirements. In consideration of the issuance of the licence, which is the subject matter of this application, the undersigned (joint and severally, if more than one) covenants and agrees to indemnify and save harmless the Township, its officers, employees, servants, agents, contractors and assigns, with respect to any and all actions, causes of action, claims, demands, proceedings, cost damages and expenses howsoever arising either directly or indirectly for the issuance of such licence and the carrying on of the business, project or other activity for which the licence is issued.

With the submission of this application, the undersigned hereby declare that the statements contained in this application are, to their knowledge, true and that this application discloses all facts known to them that are relevant thereto.

Signature of Applicant:

Clear

Signatory Name:

Personal Information contained in this form is collected under the Municipal Freedom of Information and Protection of Privacy Act RSO 1990 c M.56 for the purpose of issuing licences. Questions about this collection should be directed to the Deputy Clerk, please contact 519-669-1647 extension 6005.