FOR TOWN USE ONLY. Fifteen (15) reduced copies of the proposed draft plan of subdivision or condominium (either 8 ½ x 11 or 8 ½ x 14 format).

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APPLICATION FOR APPROVAL OF A DRAFT PLAN OF SUBDIVISION OR CONDOMINIUM DESCRIPTION (Under Section 51(17) of the Planning Act, RSO 1990, c. P. 13 or Section 9 of the Condominium Act, SO. 1998 C. 19) S-C Planning and Development Services 65 Harwood Avenue South Ajax ON L1S 2H9 Tel. 905-683-4550 Fax. 905-686-0360 www.ajax.ca FOR TOWN USE ONLY File Number Date of Receipt 1. Pre-Consultation Pre-consultation is an essential part of the planning process. In accordance with the Planning Act, the Town has passed a Pre-consultation By-law (By-law 57-2008), requiring that an applicant contact Planning to arrange a mandatory pre-consultation meeting prior to submission of a Draft Plan of Subdivision or Condominium application. The intent of this meeting is to assist in determining technical and submission requirements and conformity with the Provincial Policy documents, Durham Region Official Plan, Town of Ajax Official Plan and Zoning By-law, and any other relevant planning documents. Has the Owner/Applicant consulted Town of Ajax Planning and Development Services prior to submitting a site plan application? If, please contact the Town of Ajax Planning and Development Services to arrange a mandatory pre-consultation meeting in accordance with By-law 57-2008, as amended, prior to submission of this application. 2. Submission Requirements Information Requirements One (1) original and thirty (30) copies of this application form are to be submitted to the Town of Ajax Planning and Development Services, 65 Harwood Avenue South, Ajax, Ontario L1S 2H9. Fifty (50) copies of the proposed draft plan of subdivision or condominium, folded to a size suitable for mailing (either 8 ½ x 11, or 8 ½ x 14 format). Unfolded or rolled drawings will not be accepted. Each copy of the draft plan shall indicate the information requirements provided under Section 51 (17) of the Planning Act, RSO 1990, c. P. 13, and indicated clearly on the face of the Plan. Fifteen (15) reduced copies of the proposed draft plan of subdivision or condominium (either 8 ½ x 11 or 8 ½ x 14 format). Seven (7) copies of all supporting reports and documentation, as provided within Section 20 of this application, and as indicated on the Preconsultation Checklist Form. Seven (7) copies of a Site Screening Questionnaire, or Phase 1 Environmental Assessment, as provided within Section 12 of this application. Electronic version of all drawings and studies on a compact disc in both PDF and AutoCAD form. The digital file should be an exact representation of the paper submission. Town of Ajax Fees An application fee, in accordance with the Planning Act Fees and Charges By-law, as amended, payable to the Corporation of the Town of Ajax, is required. Payments may be made by cheque, cash or money order. (Under the authority of the Planning Act Fees and Charges By-law, as amended) Fee Submitted: $ Refund Policy (Under the authority of the Planning Act Fees and Charges By-law, as amended) A refund of Town of Ajax Application fees will be calculated as follows: Where an application is withdrawn after a file has been opened, but before it has been circulated: 90% Where an application is withdrawn after a file has been circulated, but before it has been considered at a public meeting: 50% Where an application is withdrawn after the file has been considered at a public meeting: refund Page 1 of 13

Conservation Authority Fees Payment of fees in accordance with their schedule to the Central Lake Ontario Conservation Authority or the Toronto and Region Conservation Authority, for lands potentially affected by flooding and erosion within their jurisdiction. Durham Region Fees. Payment of fees in accordance with their schedule to the Regional Municipality of Durham, as the Regional Planning review fee.. Payment of fees in accordance with their schedule to the Regional Municipality of Durham, for any developments proposed on private services, which is the Regional Health Department s review fee. Other Fees (Under the authority of the Planning Act Fees and Charges By-law, as amended) Additional costs for the processing of the application may be charged where studies in support of an application must be reviewed by persons not employed by the Town but retained for that purpose due to an expertise in the area of the study. This requirement applies to matters such as, but not limited to, the review of traffic, marketing, environmental, noise, and engineering reports, etc., in all cases the Town shall notify the applicant to seek approval and payment before proceeding to a third party review of supporting studies. Additional costs for advertising may be charged where it is not possible or appropriate for public notice of an application to be placed on the Community Page of the Ajax News Advertiser. Please be advised that a sign will be required to inform the public of the proposed development. Planning and Development Services will provide the necessary requirements and standards. The applicant will be responsible for the costs to the Town of appearing in support of the application at hearings of the Ontario Municipal Board or Environmental Assessment Board. The applicant will be required to pay the reasonable legal fees of the Town for the preparation and registration of development agreements when such agreements are required. An additional non-refundable fee of $500 when more than one public open house and one public meeting by the Community Affairs and Planning Committee are required. 3. Earlier Application Is this a resubmission of an earlier plan? Don t Know If, please indicate previous File Number(s): 4. Contact Information Mailing Address Telephone Facsimile E-mail Owner ( ) ( ) Applicant ( ) ( ) Agent or Primary Consultant ( ) ( ) Other: (specify) ( ) ( ) Page 2 of 13

Correspondence relating to this application should be sent to (select one only): The applicant is: Owner Applicant Agent or Primary Consultant Other Owner Lessee of Land or Tenant Prospective Owner If the applicant is not the Owner, the Owner must consent to the proposed Zoning By-law Amendment. Separate Letter of Authorization attached Owner s Signature: Date: Don t Know Are there any mortgagees, holders of charges or other encumbrances affecting the subject land? If, please indicate their names and addresses: 5. Details of the Subject Lands Location and Description Municipal Address Lot/Part # Plan/Concession # Assessment Roll # & PIN # Site Characteristics Frontage (m) Land Area (ha) Buildable Area (m 2 ) Average Depth (m) Average Width (m) 6. Interests and Encumbrances Are there any existing easements, rights-of-way, restrictive covenants or Aboriginal land claims negotiations affecting the subject lands, or is it covered by a Provincial/Aboriginal co-management agreement? If yes, please describe: Are there any existing easements, rights-of-way, or other rights over adjacent properties affecting the subject lands? If yes, please describe and illustrate on the submitted plan: Page 3 of 13

Does the Owner have an interest in nearby or adjoining lands? If yes, please indicate the location and area of adjoining or nearby land in which the Owner has an interest: 7. Current Planning Status Please provide the information below: Existing Land Use Designation(s) in the Durham Regional Official Plan Existing Land Use Designation(s) in the Town of Ajax Official Plan Existing Zoning 8. Current and Previous Use of the Subject Lands Please provide the information below: Current Use of the Subject Lands Previous and Historic Use of the Subject Lands, if different than the above 9. Other Planning Applications or Approvals Required Indicate whether the subject land, or land within 120 metres of the subject land is or has ever been, the subject of the following planning applications: Application Type Submitted? yes no File. Status Durham Regional Official Plan Amendment Official Plan Amendment Zoning By-law Amendment Site Plan Land Division (Severance) Minor Variance or Other (Specify) Page 4 of 13

10. Consistency with Provincial Policies and Plans Please provide the information outlined below. Provincial Policies, Plans and Interests Applies? Explain Indicate whether the requested amendment is consistent with the Provincial Policy Statements issued under subsection 3(1) of the Planning Act. Is the subject land within an area of land designated under any provincial plan or plans? If the answer to the above question is yes, does it conform to, or does it not conflict with the provincial plan or plans? Is a separate document(s) providing the above information attached? If yes, please indicate the date of the report and the author in the space provided. Author(s) and Report Title(s) Date 11. Proposed Land Uses Please provide the information below: Proposed Land Use Proposed. of Dwelling Units Proposed. of Lots and/or Blocks on Draft Plan Land Area (hectares) Net Density (Dwelling Units per hectare) Total Parking Spaces Description of Proposed Use Single Detached Residential n/a Semi-detached Residential n/a Multiple Attached Residential n/a Page 5 of 13

Proposed Land Use Proposed. of Dwelling Units Proposed. of Lots and/or Blocks on Draft Plan Land Area (hectares) Net Density (Dwelling Units per hectare) Total Parking Spaces Description of Proposed Use Apartment Residential n/a Seasonal Residential n/a Mobile Home n/a Other Residential (Specify) Commercial Nil Nil Industrial Nil Nil Parks Nil Nil n/a Open Space/ Environmental Protection/Hazard Nil Nil n/a Institutional (Specify) Nil Nil Roads Nil Nil n/a n/a Other (Specify) Nil Nil Total Page 6 of 13

12. Site Contamination A Phase 1 Environmental Site Assessment or a Completed Site Screening Questionnaire is required for all applications. Please indicate the date of the report and the author in the space provided. A Phase 2 or Phase 3 Environmental Site Assessment may be required depending on site conditions. Author Date 13. Additional Information Requirements for Condominium Applications Only Has a Site Plan for the Proposed Condominium been approved? If yes, has a Site Plan Agreement been entered into? Has a building permit for the proposed condominium been issued? Has construction for the proposed development commenced? Has construction for the proposed condominium been completed? If yes, indicated the date of completion: Please indicate if the following information is provided with the submission: A plan of survey showing the perimeter of the horizontal surface of the land and the perimeter of the buildings; Architectural plans of the buildings and, if there are any, structural plans of the buildings; A specification of the boundaries of each unit by reference to the buildings or other monuments; Diagrams showing the shape and dimensions of each unit and the location of each unit in relation to the other units and the buildings; A certificate of an architect that all buildings have been constructed in accordance with the regulations and, if there are structural plans, a certificate of an engineer that all buildings have been constructed in accordance with the regulations; A certificate signed by an Ontario Land Surveyor licensed under the Surveyors Act stating that the diagrams of the units are substantially accurate; A description of all interests appurtenant to the land that are included in the property; and A description of the property including common element. Is this a conversion of a building containing rental residential units? If yes, please refer to the applicable Regional and Area Municipal Official Plan policies indicating the conditions to be satisfied pertaining to the provisions of an adequate supply of rental accommodation in the Region and the Town. In addition, please indicate the number of units proposed to be converted: 14. Minimum Distance Separation Requirement Is there a livestock barn or manure storage facility located within 500 metres (1,640 ft.) of the boundary of the subject land? If yes, please complete the attached Minimum Distance Separation Data Sheet. Page 7 of 13

15. Servicing and Infrastructure Are the water, sewage, storm water and/or road works associated with the subject application subject to the provisions of the Environmental Assessment Act? If yes, please explain, and attach a statement prepared by a qualified engineer explaining the nature of the works and class(es) of Environmental Assessment required. Is the development proposed to be serviced by a municipal owned and operated piped sewage system? Is the development proposed to be serviced by a privately owned and operated individual septic system? Is the development proposed to be serviced by a privately owned and operated individual or communal septic system? Is the development proposed to be serviced by a municipal piped water system? Is the development proposed to be serviced by a privately owned and operated individual or communal well, a lake or other water body? Is the development proposed to be serviced by other sources of potable water? *All developments proposed on individual, on-site servicing systems or tanks will require a Geotechnical Report and a Hydrogeological Report. 16. Servicing Options Please specify whether the following servicing options apply: 16.1 A proposed development of more than five (5) lots or units on privately owned and operated individual or communal wells? 16.2 A proposed development of five (5) or more lots or units on privately owned and operated individual or communal septic systems? 16.3 A proposed development of fewer than five (5) lots or units on privately owned and operated individual or communal septic systems, and more than 4500 litres of effluent would be produced per day as a result of the development being completed? 16.4 A proposed development of fewer than five (5) lots or units on privately owned and operated individual or communal septic systems, and 4500 litres or less would be produced per day as a result of the development being completed? If the answer to 16.1, 16.2 or 16.3 is yes, please provide: a Servicing Options Report a Hydrogeological Report If the answer to 16.4 is yes, please provide: a Hydrogeological Report Page 8 of 13

17. Storm Drainage Please indicate the proposed method of storm drainage: Storm Sewers Ditches Drainage Swales Other Means (specify 18. Archaeological Potential Please answer the following regarding archaeological potential: Does the subject land contain any areas of archaeological potential? If the plan permits development on land that contains known archaeological resources or areas of archaeological potential, please provide: An archaeological assessment prepared by a person that is effective with respect to the subject land, issued under Part VI (Conservation of Resources or Archaeological Value) of the Ontario Heritage Act; and A conservation plan for any archaeological resources identified in the assessment. 19. Access Please specify the nature of the access to the subject lands Road Water Provincial Highway Regional Road If by water, please specify the parking and docking facilities to be used and the approximate distance from the subject land and the nearest public road. Municipal Road Other Public Road or Right-of-way (specify) Page 9 of 13

20. Supporting Documentation The Town of Ajax Official Plan outlines information requirements for various types of amendments. Indicate whether the Official Plan policy is applicable, and reference the attached document which addresses the policy. Type of Application Policy Applies? Report Reference Planning Rationale, addressing land use compatibility, conformity to Town s Official Plan, Zoning By-law; Durham Region Official Plan, relevant Provincial Policy documents, any of the relevant planning documents and urban design guidelines, description of proposal, why proposal is considered good planning, including evaluation of potential impacts. Environmental Impact Study (EIS) for lands within 120 metres of an evaluated wetland or within 50 metres of other features designated Environmental Protection Environmental Review Study, for lands identified as Environmental Resource Overlay within Schedule B, and for which an EIS has not been completed. 5.7 (a) 2.2.2 b) & 5.2 5.7 (o) 2.2.3 & 5.3 5.7 (o) Retail Impact Study for retail proposals above 2500 m 2 in Central Areas. 2.4.1 (h) & 5.7 cc) Traffic/Transit Impact Analysis, for new developments in the Uptown Central Area. 2.4.5 (d) & 5.7 (b) Development and Urban Design Criteria, for new developments in the Uptown and Downtown Central Areas, addressing access, circulation, parking, landscaping, outdoor amenity areas, building heights and shadows for buildings exceeding six stories in height, and noise attenuation. Environmental Site Assessment, for lands identified as potentially contaminated. 2.4.2 (b), 2.4.3 (f), (h) & (i), 2.4.4 (c), 2.4.4.9 & 2.4.5 (l) 2.7.10 (e) & 5.7 (p) (See Section 10) Heritage Impact Statement, identifying potential impacts on existing heritage features, in proximity to properties designated under the Ontario Heritage Act. 3.2.2 (f) & 5.7 (e) Archaeological Assessment, for lands with archaeological potential. Traffic Impact Study, for proposals determined to have an impact on the municipal transportation system. 3.2.2 (g) & 5.7 (f) 4.1.3 (g) & 5.7 (b) Functional Servicing Plan, for major development applications, in consultation with the applicable Conservation Authority and the Region of Durham. 4.2.2 (a) & 5.7 (j) Stormwater Management Plan, in keeping with the municipal planning principals. 4.2.4 (a) & 5.7 (h) ise Study for residential and noise sensitive uses within 300 metres of a railway, or adjacent to a Type A or type B Arterial Road, and a Vibration Study for lands within 75 metres of a railway. 5.7 (g) Is a separate document providing the above information attached Page 10 of 13

21. Other Information Although not required, the submission of additional technical and information reports may be helpful in appraising the proposal, and may be identified either through pro-consultation or through the processing of the application. If there are additional reports and documentation as part of this submission that are not otherwise addressed in this application, pleas list by Title, Author and Date: 22. Affidavit and Sworn Declaration of Owner or Application I agree that all studies submitted in support of this application may be made available for public review, pursuant to the Municipal Freedom of Information and Protection of Privacy Act. I agree to reimburse the Town of Ajax for any costs associated with the preparation of studies required to evaluate the application by qualified consultants, and any costs which may be incurred before the courts and tribunals arising from the disposition of this application. I hereby certify that all statements contained within this application are true and agree to allow Town staff reasonable access to the property. Declared before me at the of In the of this day of, 20 Commissioner of Oaths Signature of Owner or Applicant Date Personal information contained on this form is collected under the authority of the Planning Act, RSO 1990, c. P13, as amended, and the applicable implementing Ontario Regulation, and will be used to evaluate the Approval of a Draft Plan of Subdivision or Condominium application. Questions about the collection of personal information should be directed to the Records Manager/FOI Co-ordinator, 65 Harwood Avenue South, Ajax, Ontario, L1S 2H9, (905) 683-4550, ext. 3343. If you have any comments on the format or content of this application form, please complete a Customer Feedback Form, which is available at Planning and Development Services, Town of Ajax. Page 11 of 13

Minimum Distance Separation Data Sheet This is to be completed and attached to the application when applying for a new non-farm use within 500 metres (1,640 feet) of an existing livestock facility. Complete one sheet for each different set of buildings used for housing livestock. Owner of Livestock Facility: Telephone: Lot: Twp: Concession: Closest distance from livestock facility to the property boundary of the new lot(s) or the change in land use (metres) Closest distance from manure storage to the property boundary of the new lot(s) or the change in land use (metres) Tillable Hectares Where Livestock Facility Located: DAIRY BEEF SWINE Type of Livestock Maximum Housing Capacity # Manure System (Check One Box) Milking Cows Heifers Cows (Barn Confinement) Cows (Barn with yard) Feeders (Barn confinement) Feeders (Barn with yard) Sows Weaners Feeder Hogs POULTRY Chicken Broiler/Roaster Caged Layers Chicken Breeder Layers Pullets Meat Turkeys (>10kg) Meat Turkeys (5-10kg) Meat Turkeys (< 5kg) Turkeys Breeder Layers Covered Tank Open Solid Storage Open Liquid Tank Earthen Manure Storage Page 12 of 13

SHEEP Type of Livestock Maximum Housing Capacity # Manure System (Check One Box) HORSES Adult Sheep Feeder Lambs Mink - Adults White Veal Calves GOATS Adult Goats Feeder Goats OTHER Covered Tank Open Solid Storage Open Liquid Tank Earthen Manure Storage The above information was supplied by: (Please print) Name: Signature: Firm (if applicable) PART II - TO BE COMPLETED BY THE REGION File/Application. Minimum Separation Distance: Does the Application Comply With the MDS Requirements? Prepared by: Date: Page 13 of 13