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Request for 9-1-1 Sign

Property Owner’s Name(s):

Phone number:

Email Address:

Address:

Request Date:

To determine a civic address, a distance measurement is taken to the centre of the driveway; therefore, the driveway MUST be in and marked with a name sign.

Driveway will be Marked By (Date):

Tax Assessment Roll Number:

Road Name (that driveway intersects with):

Legal Description of Property Requiring 9-1-1 Sign:

Concession:

Lot:

Part:

Plan:

Geographic Township of:

Municipality of:

Building Permit #:

Please attach a copy of the municipal entrance permit if applicable.

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There is a fee of $150.00 to cover the cost of the supply and installation of civic addressing signage. This fee must be included with this application. Also, there will be a fee of $25.00 for any cheque returned NSF.