County of Peterborough Land Division
470 Water Street, Peterborough, Ontario K9H 3M3
email: AHamilton@ptbocounty.ca
T-705-743-3718 or 800-710-9586, Ext. 2406 Fax: 705-876-1730
Application for Consent
2015-12-01
Note to Applicant: All questions must be answered or
application may be returned.
Application Fee: $1150.00 must accompany fully completed
application and 6 copies.
It is strongly advised the applicant complete a Preliminary
Severance Review with the County of Peterborough
Planning Department. Have you done so:
Y/N _______________ Date: ____________________
If yes, were there any Studies required? Y/N ______
(i.e. Traffic Study, Archaeological Study and
Environmental Impact Analysis (EIA).
Have you attached 4 copies of each to this application?
Y/N _______________
Office Use:
File No.
B-
Date Received:
1.
Owner Information
Name(s): ____________________________________________
Address: ________________________________________
P.O. Box: ________________________________________
City/Province: _____________________________________
Phone: (H) ________________
(B) ______________________
Postal Code: ____________________________________
E
-mail: ____________________________________
Do you wish to receive all communications?
Yes No
2.
Authorized Agent/Solicitor Information
Name(s): ____________________________________________
Address: ________________________________________
P.O. Box: ________________________________________
City/Province: _____________________________________
Phone: (H) ________________
(B) ______________________
Postal Code: ____________________________________
E
-mail: ____________________________________
Do you wis
h to receive all communications? Yes No
3.
Ward: ____________________
Township: ____________________
____
Lot: __________
Concession: __________
Municipal (911) Address: _____________________________________
_
Tax Roll
#: _____________________________
Registered Plan #: ___________________________________________
_
Block/Lot: ______________________________
4.
Type and Purpose of Proposed Transaction
Transfer:
Creation of a New Lot Addition to a Lot (moving/adjusting lot line)
Other:
Right-of-Way Easement Correction of Title Charge Lease
5.
Transferee
If known, the name of the person(s), to whom land or interest in land is intended to be transferred, charged or leased:
_____________________________________________________ relationship to owner: _____________________
Address: ________________________________________________________________________________________________
Phone: (H) ________________
(B) ______________________
E
-mail: ____________________________________
County of Peterborough Land Division Page 2
6.
Description of Severed Lot (provide both metric & imperial measurements and include all dimensions on sketch)
Frontage (metres): __________________
_
Depth (metres): ________________
Area (m
2
or hectares): ______________
Frontage (feet): _____________________
Depth (feet): __________________
Area (ft
2
or acres): __________________
Existing Use: (i.e. residential, commercial, recreational)
_________________________________________________
Name Existing
Buildings & Structures, including well & septic
(and show on sketch with setbacks )
_________________________________________________
Proposed Use: (i.e. residential, commercial, recreational)
___________________________________________________
Name Pro
posed Buildings & Structures, including well & septic
(and show on sketch with setbacks )
___________________________________________________
Type of Access:
Municipal maintained road
County Road
Provincial Highway
Seasonally maintained municipal road
Private road or right-of-way
Other _____________
Water Parking/docking facilities distance from these to the nearest road :________________
Water Supply:
Publicly owned/operated piped water system
Privately owned/operated individual well
Privately owned/operated communal well
Lake or other water body
Other _________________________
Sewage Disposal:
(if existing, show on sketch)
Publicly owned/operated sanitary sewage system
Privately owned/operated individual septic tank
Privately owned/operated communal septic tank
Privy
Other __________________________
If a septic system exists on the severed parcel, when was it installed and inspected? _______________________
H
ow far is it located from the lot line(s) & well? ____(ft. or meters)
Have you shown the well & septic locations and setbacks on the sketch? _______
If the severed lot is an “Addition” or “Lot Line Adjustment”, please provide the following information.
If not, please skip this section and move onto Section 8:
7.
Description of Lot Being Added To
(provide both metric & imperial measurements and include all dimensions on sketch)
Frontage (metres): ___________________
Depth (metres): ________________
Area (m
2
or hectares): ______________
Frontage (feet): _____________________
Depth (feet): __________________
Area (ft
2
or acres): __________________
Existing Use: (i.e. residential, commercial, recreational)
_______________________________________________
Name Exi
sting Buildings & Structures, including wells & septic
(and
show on sketch with setbacks )
_________________________________________________
Proposed Use: (i.e. residential, commercial, recreational)
___________________________________________________
N
ame Proposed Buildings & Structures, including wells & septic
(and show on sketch with setbacks )
___________________________________________________
Official Plan Designation: __________________________ Current Zoning: ___________________________________
Type of Access:
Municipal maintained road
County Road
Provincial Highway
Seasonally maintained municipal road
Private road or right-of-way
Water
Other _____________
Roll # of Lot Being Added to: ______________________________________
County of Peterborough Land Division Page 3
8.
Description of Retained Lot (provide both metric & imperial measurements and include all dimensions on sketch)
Frontage (metres): ___________________
Depth (metres): ________________
Area (m
2
or hectares): ______________
Frontage (feet): _____________________
Depth (feet): __________________
Area (ft
2
or acres): __________________
Existing Use: (i.e. residential, commercial, recreational)
_________________
______________________________
Name
Existing Buildings & Structures, including wells & septic
(
and show on sketch with setbacks )
_________________________________________________
Proposed Use: (i.e. residential, commercial, recreational)
___________________________________________________
Name
Proposed Buildings & Structures, including wells & septic
(and show on sketch with setbacks )
_________________________________________________
__
Type of Access:
Municipal maintained road
County Road
Provincial Highway
Seasonally maintained municipal road
Private road or right-of-way
Other _____________
Water Parking/docking facilities distance from these to the nearest road :________________
Water Supply:
Publicly owned/operated piped water system
Privately owned/operated individual well
Privately owned/operated communal well
Lake or other water body
Other _________________________
Sewage Disposal: (if
existing, show on sketch)
Publicly owned/operated sanitary sewage system
Privately owned/operated individual septic tank
Privately owned/operated communal septic tank
Privy
Other _________________________
If a
septic system exists on the retained parcel, when was it installed and inspected? _________________
H
ow far is it located from the lot line(s) & well? ____(ft. or meters)
Have you shown the well & septic locations and setbacks on the sketch? _______
9.
Local Planning Documents
What is the current Township Official Plan designation on this property? _____________________________________
What is the current
County Official Plan designation on this property? _____________________________________
(this information is available from
the Preliminary Severance Review and/or from the Township)
Explain how the application Conforms with the current Official Plans:
_____________________________________
What is the current zoning on this property, as found in the Township
Zoning By-Law? _________________________
(this information is available from the Preliminary Severance Review and/or from the Township)
10.
Provincial Policy
Is the application consistent with the Provincial Policy Statements?
(this information is available from t
he Preliminary Severance Review and/or from the County Planning Dept.)
Explain how the application
is consistent: _____________________________________
______________________________________________________________________
________________________
Yes
No
Is the subject property within an area of land designated under any provincial plan(s)?
(
Oak Ridges Moraine Conservation Plan applies to portions of Cavan Ward only;
Growth Plan applies to the entire County of Peterborough so answer should be yes)
X Yes
No
If yes,
explain how the application conforms or does not conflict with provincial plan(s)? ______________________
______________________________________________________________________________________________
11.
Restrictions of Subject Land
Are there any easements or restrictive covenants (i.e. hydro, Bell) affecting the subject land?
If yes, describe the easement or covenant and its effect: __________________________________
________________________________________________________________________________
Yes
No
County of Peterborough Land Division Page 4
12.
Previous Planning Act Applications
Is the subject land now, or has it been, the subject of an application for a
Plan of Subdivision under Section
51 or a consent under Section 53 of the
Planning Act?
Yes
No
Has the owner of th
e subject land severed any land from the original acquired parcel?
If yes, indicate this information on the required sketch and provide the following (if known):
File No. B
- __________, Transferee: _________________________ Date of Transfer: ______________
File No. B
- __________, Transferee: _________________________ Date of Transfer: ______________
Yes
No
Is this land currently the subject of any other application under the Planning Act, such as an application for
Official Plan Amendment, Zoning By
-Law Amendment, Minor Variance, Minister’s Order, or Power of Sale?
If yes, please provide the
following:
Type: _________________________
File No. ______________________ Status: __________________
Yes
No
13.
Minimum Distance Separation (MDS)
Are there any
barns within 750-1,500 metres (2,460-4,921 feet) of the subject property which currently
house, or are capable of housing, livestock?
Are there any
anaerobic digesters within 750-1,500 metres (2,460-4,921 feet) of the subject property?
If yes, please complete an “MDS Data Sheet” for each barn.
Yes
Yes
No
No
14.
Agricultural Severances (for lands within the agricultural designation only)
N/A
Is the severance to dispose of a residence surplus to a farming operation (must have 2 houses)?
Is this severance to create a new
farm parcel approximately 40 hectares (100 a
cres) in size?
Is this severance for a commercial or industrial
“agriculture-related” use?
Yes
Yes
Yes
No
No
No
15.
Adjacent Lands Surrounding the Landholding
Please state the names of the owners, the use of the land and buildings existing on the lands surrounding the applicants’ ent
ire
landholding.
This information should also be on the sketch, and can be obtained from the Township or Land Division Office.
If more room is needed, please add extra Schedule page.
Direction
Name of Owner
(only when known to the applicant)
Use of Land(must be filled in)
(i.e. farm, residential etc.)
Buildings (i.e. house, barn etc.)
(must be filled in)
North
South
East
West
16.
Driving Directions
Please describe in detail driving directions to the subject property: ____________________________________
________________
County of Peterborough Land Division Page 5
Signatures Page
If the applicant is not the owner of the subject land, a written authorization of the owner that the applicant is authorized to act as
agent and make the application on his/her behalf is required (original please).
If the applicant is a Corporation acting without agent or solicitor, the application must be signed by an Officer of the Corporation with a
declaration indicating that the said Officer has the authority to bind the Corporation and the Corporation’s Seal (if any) must be affixed.
Signature(S)
Dated at the (City, Township) of _________________________ this ______ day of _______________________ ,201____.
__________________________________________________ ____________________________________
Signature of owner(s) or authorized solicitor/agent Signature of owner(s) or authorized solicitor/agent
Declaration
This section must be signed before a Commissioner for Taking Affidavits or a designated Official of the Municipality
(i.e. Reeve, Clerk, Secretary-Treasurer of the Land Division Committee, lawyer, etc.)
I/we, _____________________________________ of the Township, City, etc. of _________________________
__________,
in the County/Region/Municipality, etc. of ______________________, solemnly declare that all the statements contained in this
application are true, and I make this solemn declaration as if made under oath and by virtue of the Canada Evidence Act.
Declared before me at the ______________ ________________________________________________
City, Township Owner or authorized Agent
of _______________________________________
Name of City, etc.
in the ____________________________________ ________________________________________________
County, Region, etc. Owner or authorized Agent
of _______________________________________
this ______day of _________________, 20____.
__________________________________________
Commissioner, etc. for taking affidavits
An “original” signed copy of the application and sketch must be submitted, together with 6
copies of both the
application and sketch, each copy stapled individually with a sketch. All copies of the sketch or survey must be
coloured red for severed lots, green for retained. Copies may be double-sided. Please submit application with
a cheque for $1150.00 payable to the “County of Peterborough”.
Personal information contained
on this
form
is
legally authorized under Sec.53
of the
Planning
Act and O.Reg.197/96 for the
purpose
of
processing your planning application
and will
become part
of a
public
record.
Pursuant
to
Sec.1.0.1
of the
Planning
Act, and in
accordance with Sec.32(e)
of the
Municipal Freedom
of Information and
Protection
of
Privacy
Act the
County
of
Peterborough may make
all
planning applications
and
supporting
material
available
to the
public
in
hard
copy
or electronically. If you
have
any
questions about
the
collection,
use or disclosure of this
information
by the
County
of
Peterborough, please contact
the
CAO
or
Clerk, County
of
Peterborough,
470 Water Street, Peterborough, Ontario K9H 3M3
County of Peterborough Land Division Page 6
Sketch or Survey Instructions and Example
Details are required under the Planning Act and by the Land Division Committee and
its circulating agencies. Failure to complete the sketch with enough information
could result in your application being deemed “incomplete” or an amended
application and fee.
You may use the “sketch” you received with your preliminary review to start.
Show the boundaries and dimensions of the subject land, i.e. the Severed lot, the Retained
lot and the parcel being added to if this is an addition to a lot (i.e. frontage, depth, area).
Show all lands and features drawn to the best of your ability - the measurements must be
reasonably accurate and proportionally sized in the context of the lot and other features.
The location & setbacks of all natural and artificial features on the subject land and on the
land that is adjacent to the subject land that, in the opinion of the applicant may affect the
application (existing buildings, proposed building locations, septic areas, wells, railways,
roads, existing entrances, watercourses, drainage ditches, river or stream banks, slopes,
wetlands and wooded areas.)
Show a proposed septic area on the undeveloped lot(s) (either severed and/or
retained) that is at least 3000 sq. ft. (eg. 50 ft. x 60 ft.) and that complies with all
regulatory and zoning setbacks from watercourses, restricted areas, proposed
buildings, wells and lot lines. To check these setbacks call the Township,
Peterborough Public Health and Conservation Authority for appropriate minimum
setbacks.see attached sample
The boundaries and dimensions of any land abutting the subject land that is owned by the
owner of the subject land (i.e. frontage, depth, area).
The distance between the subject land and the nearest township lot line or landmark
(bridge or railway crossing, etc.)
The location of all land previously severed from the parcel originally acquired by the
applicant.
The names of the owners (only when known to the applicant) of the adjacent lands and
existing uses on the adjacent land (must be included), such as residential, recreational,
agricultural and commercial uses (must be included). Also, show the distance between
the severed lot and any barns which as per dimensions outlined in Question 13 of the
application (“MDS Data Sheets” are available at the County Office or on the County
website www.ptbocounty.ca)
The location, width and name of any roads within or abutting the subject land, indicating
whether it is an unopened road allowance, a public traveled road, a private road or a right-
of-way.
If access to the subject land is by water only, the location of the parking and boat docking
facilities to be used.
The location and nature of any easement affecting the subject land.
The severed lot coloured with red stripes and the retained lot coloured with green stripes
on each of the required copies of this sketch. If access to this lot is to be by a deeded
right-of-way, colour this in yellow with red stripes if severing, green if retaining.
If the purpose of this application is for an “addition” to an existing lot, draw an arrow, in red,
from the severed land to the property to which it is to be added.
Show the direction “North” on the sketch.
County of Peterborough Land Division Page 7
Sample Sketch
Show Measurements to Septic
Minimum Setbacks
From lot line
3 metres
From house
5 metres
From wells with water tight casings to
minimum 6 metres below ground
15 metres
From other wells
30 metres
From surface water
15 metres
To Convert
Multiply By
To Find
Feet
0.3048
Metres
Acres
0.4046
Hectares
Square Feet
0.09
Square Metres
Rosa Ball
(Previous severance B-1/72)
Sylvia & Jean MacDonald
Crop Farm
Petrov & Gilda Welsh
House
Bill & Marge Sampson
House
County Road #48
Farr Road
Victor & Patsy Cameron
Beef Farm
House
Barn
Barn
Magnolia Smith Agricultural
Owen Mars
Bush Lot
Lot 5
Concession 13
Lot 5
Concession 14
76.2m (250 ft)
91.44m (300 ft)
76.2m (250 ft)
190.5m (625 ft)
Pond
House
Proposed
House
Septic
System
Barn
House
Lot to be Retained
9.7 hectares (24 acres)
Septic
System
Well
15.2m by 18.3m
(50 ft by 60 ft)
Lot to be Severed
0.4 ha (1 acre)
10m (32.8 ft)
10m (32.8 ft)
Well
Septic
System
Proposed
Well
45.72m (150 ft)
ORCA
Development
Control Area
Map not to Scale this sketch is not a final plan
Check with township office for minimum setbacks
for home and outbuildings.
5 m (16.4 ft)
5 m (16.4 ft)
County of Peterborough Land Division Page 8
Checklist for Submitting Application:
Have you completed a (free) Preliminary Severance Review with the County
Planning Department? If not, contact the County Planning Department at 743-
0380 or planning@ptbocounty.ca. You can get a Preliminary Severance Review
Form on our website at www.ptbocounty.ca.
Have you completed all questions on the application form (if the answer is
“none”, or “0”, or “n/a”, please indicate that answer to show the question has
been considered).
Incomplete applications and/or sketches (see instructions) will not be
accepted and will be returned to the applicant.
Have you completed the “MDS Data Sheet” for barns (available online or
from our Planning Department, as above)?
If you are acting as an agent for the owner, have you included a separate
“authorization” letter (please include original).
Has the declaration page (page 5) been signed and commissioned?
We require 1 (one) original and 6 (six) copies of the application and 6 (six)
copies of the sketch coloured sketches attached.
Have you included a cheque or money order made out to the “County of
Peterborough” for $1150.00?
Have you included the “original” copy of the application with the signatures
and sworn affidavits?
Have you attached all copies of any reports and/or studies required as
per your preliminary review?
The Consent process is involved and lengthy. Please be patient as it proceeds through
the various stages of the prescribed process as per the Planning Act of Ontario. Our goal
is to process the application as soon as possible given the various stages it must pass
through. Please see the “Land Severance Consent Guide” for an in-depth explanation
.
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