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THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE (Township of Oro Medonte)

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THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE
PRE-SERVICING AGREEMENT APPLICATION 2021-
Development Services – Planning Division
148 Line 7 South, Oro-Medonte, Ontario L0L 2E0
Pre-Servicing Agreement Application Page 1
Introduction
An application for approval of a Pre-Servicing Agreement is required to be submitted if an
applicant is proposing to construct on site works prior to completion of the registration process
for a Plan of Subdivision or a Plan of Condominium by the Township of Oro-Medonte.
Fees
Each application must be accompanied by the application fee in the amount of $1,500.00. This
fee has been established by the Township’s Fees and Charges By-law and is used to cover
administrative and professional costs related to the processing and review of this application.
Please note that the Township may require additional costs from the applicant depending on
the scope and complexity of issues raised in processing this application.
Required Documents
Please submit the following with this completed application:
• Copy of Survey
• Copy of Deed of Transfer showing the legal description of the subject lands and name(s)
of registered owner of the property and any/all Mortgages
• Copy of Engineering Letter of Retention
• One (1) copy of Engineering Drawings including Grading and Drainage Plan, Site
Rehabilitation Plan, Access Control Plan, and Phasing Plan
• One (1) copy of technical reports
• Cost Estimate (including the cost of works required for site controls and rehabilitation)
• One (1) digital copy of all drawings and reports in Adobe Acrobat.pdf format
• Copy of all applicable agency clearance letters or approval documents.
It is the responsibility of the applicant to provide all applicable external agencies with
the appropriate documents. Please contact the agencies directly as to the format
required.
Applicants are required to submit the Pre-Servicing Agreement Application, Required
Documentation, and the Required Fee for a complete submission to the Township.
Refer to Township of Oro-Medonte Development Engineering Policies, Access and
Design Standards for detailed submission requirements.
Office Use Only Fee ______________
Date Received _______________________ File No. ________________________
THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE
PRE-SERVICING AGREEMENT APPLICATION 2021-
Development Services – Planning Division
148 Line 7 South, Oro-Medonte, Ontario L0L 2E0
Pre-Servicing Agreement Application Page 2
Address: Postal Code:
Municipality: Lot / Concession:
Registered Plan: Assessment Roll Number:
Access: Provincial Highway County Road Local Road Private Other
Dimensions of Subject Property (in metric units)
Frontage metres
Average Width metres
Depth metres
Area hectares
TYPE OF APPLICATION
Registered Property Owner (Full Name):
Address:
Municipality: Province: Postal Code:
Telephone: Ext. Fax:
Contact Name & Email:
Applicant Name (If Applicable):
Applicant is: Agent Solicitor Planning Consultant Contractor Architect Other
Address:
Municipality: Province: Postal Code:
Telephone: Ext. Fax: _______
Contact Name & Email:
Communications should be sent to Applicant Owner Agent
1. PROPERTY INFORMATION
2. OWNERSHIP INFORMATION
3. APPLICANT INFORMATION (required if Applicant is NOT the Owner)
THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE
PRE-SERVICING AGREEMENT APPLICATION 2021-
Development Services – Planning Division
148 Line 7 South, Oro-Medonte, Ontario L0L 2E0
Pre-Servicing Agreement Application Page 3
Describe the current uses on the property:
Current Land Use Designation in the Official Plan:
Current Zoning:
Number of existing Units/Blocks:
Number of current Buildings:
Describe the proposed uses on the property:
Proposed Land Use Designation in the Official Plan:
Proposed Zoning:
Number of proposed Units/Blocks:
Number of proposed Buildings:
Is the subject land currently the subject of a proposed Official Plan Amendment, Zoning By-
law Amendment, Minister’s Zoning Order or Minor Variance? Yes No
Application No.: _______
Ontario Registration Number and status: _______
Has there ever been an industrial or commercial use, including gas station on the subject
lands or adjacent lands? Yes No Specify: _______
4. CURRENT LAND USE
5. PROPOSED LAND USES
THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE
PRE-SERVICING AGREEMENT APPLICATION 2021-
Development Services – Planning Division
148 Line 7 South, Oro-Medonte, Ontario L0L 2E0
Pre-Servicing Agreement Application Page 4
Is there reason to believe the subject lands have been contaminated by former uses on the
site or adjacent lands? Yes No Specify: _______
Has there ever been waste disposal on the subject lands or adjacent lands?
Yes No If yes, provide MOE Certificate of Approval #: _______
Identify any supporting reports prepared to date:
_________________________________________________
Water supply will be provided by:
Municipal piped and operated supply
Private individual well
Private communal well
Other – specify:
Sanitary/sewage disposal will be provided by:
Municipal owned and operated sewers/treatment facility
Privately owned and operated sewers/treatment facility
Privately owned and operated individual septic system
Privately owned and operated communal collection system
Other – specify:
If the requested proposal would permit development on a privately owned and operated
individual or communal septic system and more than 4500 litres of effluent will be produced,
has a servicing options report and a hydrogeological report been prepared? Yes No
If no, please provide reason why?
Storm drainage will be provided by:
Municipal storm sewers
Swales, ditches
Other – specify:
. 6. SERVICING
THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE
PRE-SERVICING AGREEMENT APPLICATION 2021-
Development Services – Planning Division
148 Line 7 South, Oro-Medonte, Ontario L0L 2E0
Pre-Servicing Agreement Application Page 5
a) Is the subject land within a Wellhead Protection Area (WHPA) or an Issue
Contributing Area (ICA)?
Yes No
b) If yes, please identify the WHPA/ICA?
c) If yes, do you have an Approved Risk Management Plan (RMP) and/or a Section
59 Notice to Proceed from the Risk Management Official (RMO)? (Please attach
the document you have).
Yes No
Please checkmark below to identify works proposed to be completed through this pre-
servicing agreement application:
Earth Works including _______________________________________
Drainage Works including ____________________________________
Underground Servicing including _______________________________
Road Works including _______________________________________
For any additional questions or concerns, please contact the Development Services –
Planning Division at 705-487-2171. Alternative formats are available upon request.
7. SOUTHERN GEORGIAN BAY LAKE SIMCOE SOURCE PROTECTION
THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE
PRE-SERVICING AGREEMENT APPLICATION 2021-
Development Services – Planning Division
148 Line 7 South, Oro-Medonte, Ontario L0L 2E0
Pre-Servicing Agreement Application Page 6
Declaration of Owner or Authorized Agent
I/we _____________________________________of the ________________________
of _________________________in the ________________ of ____________________
hereby apply, as previously specified, to the Corporation of the Township of Oro-Medonte. It is
expressly understood that this application is in regard only to the lands described, and is made
pursuant to the provision of The Planning Act, 1990. I understand that the personal information
on this form is being collected pursuant to the Planning Act, R.S.O., 1990 c.P.13 and will be
used in relation to the processing of this development application. I solemnly declare that all
the statements contained in this application are true, and I make this solemn declaration
conscientiously believing it to be true and knowing that it is of the same force and effect as if
made under oath and by virtue of the Canada Evidence Act.
DATED at the _______________________ of ___________________________this ______
day of __________________, 2021.
___________________________________________
(Signature of Applicant, Solicitor, or Agent)
DECLARED before me at the )
of )
in the of )
this day of 2021 )
___________________________________________
(Signature of Applicant, Solicitor, or Agent)
The personal information on this form is being
collected pursuant to the Planning Act, R.S.O.,
1990 and will be used in relation to the
procession of this consent application. If you
have any questions, please ask at the Oro-
Medonte Township Office.
________________________________
A Commissioner, etc.
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THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE
PRE-SERVICING AGREEMENT APPLICATION 2021-
Development Services – Planning Division
148 Line 7 South, Oro-Medonte, Ontario L0L 2E0
Pre-Servicing Agreement Application Page 7
Freedom of Information and Privacy
Personal information contained in this form, collected and maintained pursuant to Section 53 of
the Planning Act, will be used for the purpose of responding to the Application and creating a
public record. The Owner’s Signature acknowledges that “personal information [is] collected
and maintained specifically for the purpose of creating a record available to the general public;”
per Section 14(1)(c) of the Municipal Freedom of Information and Protection of Privacy Act,
R.S.O. 1990, c. M. 56.
The applicant acknowledges that the Township considers the application forms and all
supporting materials, including studies and drawings, filed with this application to be all public
information and to form part of the public record. With the filing of an application, the applicant
consents to the Township photocopying and releasing the application and any supporting
material either for its own use in processing the application, or at the request of the third party,
without further notification to or permission from the applicant. The applicant also hereby states
that it has authority to bind its consultants to the terms of this acknowledgement. Questions
regarding the collection of information should be directed to the Director of Development
Services at the Township of Oro-Medonte at (705)-487-2171 ext. 2123.
______________________________________ ___________________
Signature of Owner Date
______________________________________ ___________________
Signature of Owner Date
______________________________________ ___________________
Signature of Witness Date
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THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE
PRE-SERVICING AGREEMENT APPLICATION 2021-
Development Services – Planning Division
148 Line 7 South, Oro-Medonte, Ontario L0L 2E0
Pre-Servicing Agreement Application Page 8
Owner’s Authorization
Applicable if an Agent is making this application on your behalf
If the Applicant is not the Owner of the subject land of this Application, the written authorization
of the Owner stating that the Agent is authorized to make the Application on their behalf must
be included with this application form or the authorization set out below must be completed.
Please note:
If the Owner is an incorporated company, authorization of the appropriate signing officer(s) is
required in accordance with the company’s by-laws. A copy of the Articles of Incorporation
is also required to be submitted to the Township.
I/We, _______________________________ the undersigned being the Registered Owner(s)
of the subject land, hereby authorize ________________________________ to act as my
Agent with respect to the preparation and submission of this Application.
__________________________ ________________________
Signature of Owner Date
(if Corporation, I have the authority to bind the Corporation)
__________________________ ________________________
Signature of Owner Date
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THE CORPORATION OF THE TOWNSHIP OF ORO-MEDONTE (Township of Oro Medonte)

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Completed 6 April 2021

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