APPLICATION RECEIVED (date) TIME:

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1 CONSENT DEVELOPMENT APPLICATION FORM Municipality of Grey Highlands 206 Toronto Street South, Suite 1 Box 409 Markdale, Ontario, N0C 1H0 Phone (519) , Fax (519) APPLICATION RECEIVED (date) TIME: FILE NO: B /20 Application Type & Fees Required: 1. Application for Consent, $1,300.00* Payment Received (*$ for Application; $ for stamping of deed upon approval) 2. Request for Change of Condition $ Payment Received 3. Septic Review $ Payment Received (Required for All Consent Applications on Private Services) 4. Conservation Authority Fees Payment Received All applications are subject to Conservation Authority Fees for review and comment as follows: Grey Sauble Conservation Authority - $ (payable to Grey Sauble Conservation Authority) Nottawasaga Conservation Authority Billed directly to the Applicant Saugeen Valley Conservation Authority $ Billed directly to the Applicant 1. WHAT IS THE PURPOSE OF THE APPLICATION? 2. REGISTERED OWNER: Full Mailing Address: Telephone Number: Fax/ 3. APPLICANT: (if different from owner) Full Mailing Address: Telephone Number: Fax/ Address: 4. AGENT/SOLICITOR: Full mailing Address: Telephone Number: Fax/ 5. COMMUNICATIONS should be sent to one only: Owner Applicant Agent (Communication includes Signage required by the Planning Act for posting on the subject property) 6. PROVIDE A DESCRIPTION OF THE PROPERTY: Municipal Address Roll Number Concession Lot Part Reference Plan No. Registered Plan No. Area: hectares Depth: metres Frontage (width) metres acres feet feet 1

2 NOTE: A sketch illustrating the proposal must be submitted with the application (Please see Page 5 for details) 7. DESCRIPTION OF SUBJECT LAND: a) Existing use of the subject Land: Agricultural Residential Commercial Industrial Other (explain) b) Previous use of property? c) Uses of abutting properties: North East South West Note: Please complete the form found under Schedule B for each abutting property that contains an agricultural use, utilizing a separate form for each agricultural property. This information must be completed for each use in order for planning staff to calculate the Minimum Distance Separation Formulae (MDS). Kindly reference each agricultural use with a number for clarification purposes (i.e. If multiple agricultural uses exist in proximity of the subject lands, please denote each property numerically as per the sample sketch found on Schedule B-1 of the Application Form). d) Dimensions of all buildings / structures on subject land: House Detached Garage Shed/Workshop Barn(s) Other e) Is the property presently subject to any of the following: Easement Restrictive Covenants Right of Way Other Describe: f) Is the property located within the Niagara Escarpment? If Yes, provide a copy of the Development Permit or the Letter of Exemption received from the Niagara Escarpment Office with your application: 8. CURRENT PLANNING STATUS: i) Current Official Plan Designation Proposed Official Plan Designation ii) Current Zoning Proposed Zoning iii) Are any other development applications currently in process for this property? If yes, please indicate type and status 9. NAME & WIDTH OF ABUTTING ROADS, HIGHWAYS, OR OTHER PUBLIC RIGHT-OF-WAYS: 10. WATER SUPPLY: Municipal system Communal System Individual Drilled Well Individual Dug Well System Details (i.e. date installed, size, type, location) 11. SEWAGE DISPOSAL: Municipal system Communal System Individual Septic Tank System Details (i.e. date installed, size, type, location) 2

3 12. FEATURES OF THE PROPERTY AND SURROUNDING AREA: The following features are matters of provincial interest and/or relate to the Provincial Policy Statement. Please indicate if they are on the subject property or within 500 metres. (Both Columns must be completed) USE OR FEATURE An agricultural operation, including livestock facility, stockyard or crop farm A wetland on or within 120 metres of the subject lands Flood Plain: Regulatory floodline Plant & Wildlife habitat (Significant) Unstable Lands (i.e. Karst topography) Waterbodies (lake, creek, stream, pond, river, etc. and fisheries) Woodlands Cultural Heritage Resources (i.e. archaeological sites or heritage buildings) A landfill A sewage treatment plant or waste stabilization plant A rehabilitated mine, active mine site, or non-operating mine site (within 1 km) An industrial or commercial use, and specify the use(s) An active railway line A municipal, federal or private airport Crown lands Quarry (open or closed) or Aggregate deposits Other regional issues: i.e. Niagara Escarpment ON THE SUBJECT LANDS YES / NO Within 500 metres of Subject Land, (indicate approximate distance) YES / NO 13. PLEASE IDENTIFY THE AGENCIES AND/OR PERSONS YOU HAVE CONTACTED ABOUT THIS APPLICATION. 14. IS THERE ANY OTHER INFORMATION ABOUT THIS PROPERTY OF WHICH WE SHOULD BE AWARE? 15. AUTHORIZATION: NOTE: The registered property owner(s) must authorize the applicant / agent to make this application on their behalf prior to the application being processed. I (please print) am the registered owner of the lands subject to this application, and I authorize to make this application on my behalf. Dated: Signed: 3

4 16. The applicant acknowledges that, depending upon the nature of the application and the decision of Committee of Adjustment and/or Council, the applicant may be required to obtain further approvals, including other approvals under the Planning Act and/or to enter into agreements authorized under that Act. The applicant agrees to reimburse the Municipality for any costs incurred by the Municipality which relate to the preparation of such agreements and the review of associated documents (e.g. plans, storm water management reports etc.) by its solicitor, engineer or other applicable outside consultants. The applicant agrees to provide a deposit of $3,000.00, upon request, to be applied towards such costs and to pay such additional amounts as invoiced by the Municipality upon the depletion of such deposit. The Municipality shall return any unused portion of the deposit, if any, upon approval and the fulfillment of all obligations outlined in the Agreement. SIGNATURE OF APPLICANT(S) 17. AFFIDAVIT OR SWORN DECLARATION NOTE: This page is to be filled out under witness at the Municipal Office or by Applicants Solicitor. By swearing this affidavit or declaration I hereby: Grant access to the property by Municipal Staff and Council or Committee members for the purpose of site visits related to this application; Acknowledge that all documents which have been submitted as part of this application are considered public documents and that such documents may be made available for viewing by the Public as part of the Planning Application process on the Municipality s Website or as a Counter Copy for viewing purposes; And declare that I / we have provided a copy of the deed for the subject parcel. I/We (Applicant) of the (City/Township) in the County / District / Regional Municipality of make oath and say (or solemnly declare) that the information contained in this application is true and that the information contained in the documents that accompany this application in respect of this application is true. Sworn (or declared) before me at the of in the of this day of 20 SIGNATURE - Commissioner of Oaths SIGNATURE OF APPLICANT(S) NAME IN PRINT APPLICANT(S) - NAME IN PRINT Please Note: Applications will not be received by the Municipality unless the following is provided. Application form, fully completed including appropriate fees Copy of Deed Owner's signature and/or signed authorization A sketch or plans illustrating the proposal 4

5 SKETCH REQUIREMENTS FOR CONSENT APPLICATION 5

6 Schedule A: Application for Consent CONSENT 1. Purpose of this Application 1.1 Type and purpose of proposed transaction (check appropriate box) [ ] Transfer [ ] Creation of a new lot [ ] Addition to a lot [ ] An easement [ ] Other purpose [ ] Other [ ] A charge [ ] A lease [ ] A Correction of title 1.2 Name of person(s), if known, to whom land or interest in land is to be transferred, leased or charged 1.3 Name and address of Mortgagor (for circulation and release purposes) 1.4 If a lot addition, identify the lands to which the parcel will be added ( ie) address, lot and plan number 2. Description of Subject Land and Servicing Information (Complete each subsection.) 2.1 Description Frontage (m.) Depth (m.) Area (ha.) 2.2 Use of Property Existing Use(s) Proposed Use(s) 2.3 Buildings or Structures Existing Proposed Severed Retained 2.4 Access (Check appropriate space) Provincial Highway Municipal road, maintained all year Municipal road, seasonally maintained Other public road Right of way Water Access (If so, describe below) Describe in section 9.1, the parking and docking facilities to be used and the approximate distance of these facilities from the subject land and the nearest public road. 2.5 If access to the subject land is by private road, or if "other public road" or "right of way" indicate who owns the land or road, who is responsible for its maintenance and whether it is maintained seasonally or all year. 3.0 Has a previous severance been granted? If yes, please indicate date and details: 6

7 Schedule B: Agricultural Property Information (Required for Minimum Distance Separation Calculations) 1. What type of farming has been or is currently being conducted on the property? Please indicate by circling an Animal Type, Description and Barn Type from the chart below. Animal Type Description Barn Type Beef Cows, including calves to weaning (all breeds) Feeders (7 16 months) Backgrounders ( months) Shortkeepers ( months) Dairy Cattle Milking Age Cows (dry or milking) Large-framed; 545 kg. 636 kg (e.g. Holsteins) Medium-framed; 455 kg 545 kg (e.g. Guernseys) Small-framed; 364 kg = 455 kg (e.g. Jerseys) Heifers (5 months to freshening) Large-framed; 182 kg 545 kg (e.g. Holsteins) Medium-framed; 39 kg 148 kg (e.g. Guernseys) Small-framed; 364 kg 455 kg (e.g. Jerseys) Confinement Yard / Barn Confinement Total Slats Confinement Bedded Pack Deep Bedded Free Stall Manure Pack Outside Access Pack Scrape 1 Side Pack Scrape 2 Sides 3 Row Free Stall 4 Row Free Stall (Head to Head) 4 Row Free Stall (Tail to Tail) 6 Row Free Stall Sand Tie Stall Swine Sheep Chickens Turkeys Horses Other (Goats, Ostriches, etc.) Calves (0 to 5 months) Large-framed; 45 kg 182 kg (e.g. Holsteins) Medium-framed; 39 kg 148 kg (e.g. Guernseys) Small-framed; 30 kg 125 kg (e.g. Jerseys) Sows with litter, Segregated Early Weaning Sows with litter, Non-Segregated Early Weaning Breeder Gilts (Entire Barn Designed for This) Weaners (7 kg 27 kg) Feeders (27 kg 105 kg) Ewes & Rams (for meat) Ewes & Rams (dairy operation) Lambs (Dairy or Feeder Lambs) Layer Hens (for eating eggs) Layer Pullets Broiler Breeder Growers (transferred to layer barn) Broiler Breeder Layers (transferred to grower barn) Broilers on an 8 week cycle Broilers on a 9 week cycle Broilers on a 10 week cycle Broilers on a 12 week cycle Broilers on any other cycle Turkey Pullets Turkey Breeder Layers Breeder Toms Broilers Hends Toms (day olds to over 10.8 kg to 20 kg) Turkeys at any other weights Large-Framed, mature; greater than 681 kg Medium-Framed, mature; 227 kg 680 kg Small-Framed, mature; less than 227 kg Deep Bedded Full Slats Partial Slats Solid Scrape Non-Segregated Early Weaning Segregated Early Weaning Confinment Outside Access Cages Litter with Slats Litter Information not required Information not required 2. Number of tillable hectares (acres) on property: (Hectares) (Acres) 3. Capacity of barn in terms of livestock units: 4. Manure Storage Facility (please indicate most appropriate type from the list below): Solid, Inside, bedded pack (V1) Solid, Outside, covered (V2) Solid, Outside, no cover (V3), greater than or equal to 30% dry matter Solid, Outside, no cover (V4), 18-30% dry matter with covered liquid runoff storage Solid, Outside, no cover (L1), 18 30% dry matter with uncovered liquid runoff storage) Liquid, Inside, Underneath Slatted Floor (V5) Liquid, Outside, with a tight fitting cover (V6) Liquid, Outside, no cover anaerobic digester (V7) Liquid, Outside, permanent floating cover (V8) Liquid, Outside, No Cover, Straight-wall (M1) Liquid, Outside, Roof, Open Sides (M2) Liquid, Outside, No Cover, Sloped-sided (H1) 7

8 100m 1000m 35 Sideroad (Public Road) Schedule B-1: Sketch Required for Agricultural Property Information (Required for Minimum Distance Separation Calculations) SKETCH - YOU MUST SHOW ALL OF THE REQUIRED INFORMATION a) "NORTH ARROW" b) "Subject Lands" - all land owned by the applicant - boundaries and dimensions c) The distance between the applicants land and the nearest township lot line or appropriate landmark (i.e. bridge, raliway crossing, etc.) d) The parcel of land that is the subject of the application, its boundaries and dimensions, the part of the parcel that is to be severed, the part that is to be retained and the location of all land previously severed e) The approximate location of all natural and artificial features on the subject land (e.g buildings, railways, roads, watercourses, drainage ditches, river or stream banks, wetlands, wooded areas, wells, septic tanks) and the location of any of these features on adjacent lands which may affect the application. f) The use of adjoining land (i.e. residential, agricultural, cottage, commercial, etc.) g) The location, width and names of all road allowances, right-of-ways, streets, or highways within or abutting the property, indicating whether they are publicly travelled roads, private roads, rights-of-way or unopened road allowances h) The location and nature of any easement affecting the subject land i) All barns and manure storage facilities on the subject property as well as on the adjacent lands. Please indicate the distance from the barns and the manure storage facilities to the proposed severance boundary. Please be sure to indicate the corresponding barn number and manure storage facility number identified on the livestock form and the agricultural property history page (see sample sketch for details) SAMPLE SKETCH VACANT RESIDENTIAL RESIDENTIAL RESIDENTIAL VACANT WOODED AREA STREAM SUBJECT PROPERTY éééééééééééééééééééééééééééé éééééééé éééééé VACANT RESIDENTIAL Manure Storage 1 Barn 1 GREY ROAD 4 (Public Road) House Manure Storage RETAINED 150m 100m House 300m 2 175m 200m 2 Barn (2) SEVERED 100m 200m 225m 300m 350m 3 Manure Storage House Barn (3) 3 Manure Storage 4 Barn (4) 4 House 8