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NOTE TO APPLICANTS: Consent Application Form Prior to submission of an application for consent to create a new lot or an addition to a lot, the Committee of Adjustment recommends that the applicant and/or the agent contact Regional and Town Planning staff to review their proposal. Also, in situations where a watercourse or wetlands are located on or in proximity to the subject lands, please contact Halton Conservation staff prior to submission of an application. The applicant is also encouraged to communicate with neighbours with respect to this application. In this form the term subject land means the land to be severed and the land to be retained. COMPLETENESS OF APPLICATION: As of January 1st, 1999, the Town of Oakville became the approval authority for consent applications. When completing the application form please note the following: 1. Please answer all questions. Type or print clearly. 2. The Town will contact and correspond, during the processing of this application, with the APPLICANT as listed below. 3. The information in italics on this form is the prescribed information required by Ontario Regulation 197/96 Schedule 1, for submission of a consent application made under the Planning Act. 4. The application form also sets out other required information that will assist the Town of Oakville and others in their planning evaluation of the consent application. To ensure the quickest and most complete review, this information SHOULD be submitted at the time of the application. In the absence of this information, it may not be possible to do a complete review within the legislated time frame for making a decision. As a consequence, it may result in the denial of the application. 5. In order that the Building Services Department can process this application, the AUTHORIZED AGENT and the LAND OWNER must sign the attached Affidavit. 6. If the mandatory information and fee are not provided, the Town of Oakville will RETURN the application, or REFUSE to further consider the application until the information and fee have been provided. SUBMISSION OF THE APPLICATION: Application Fees Application Form with original signatures plus 25 (two sided) copies of pages 4 to 8 Surveyor s Sketch with a key map and refer to 1.3 Guidelines & Procedures for all requirements) One full size copy plus 25 copies on 8½ x 14 paper required Owner s Authorization Affidavit Halton Region - Environmental Site Screening Checklist A Tree Inventory and Protection Plan One complete application form is required for each parcel to be severed, along with the applicable fee as indicated on the Fee Schedule. - 1 -

Guidelines & Procedures for Consent Applications 1.1 Application Form One (1) original application (signed and witnessed by a Commissioner for taking Affidavits) and 25 (two sided) copies of pages 4 to 8 (to be used to consult with other agencies that may have an interest in the application). A completed application is required for each parcel to be severed. If the form is incomplete or inaccurate, the application will be returned for completion, correction or clarification prior to processing. 1.2 Application Fees Effective January 1, 2018 APPLICATION FEES INDIVIDUAL CHEQUES Town of Oakville Fee 8,400.00 - Validation of Title 3,145.00 Region of Halton Fee - Revision Fee - Validation of Title 1,095.11 286.97 253.95 Halton Region Conservation Authority (Major) 2,050.00 (Minor) 875.00 Credit Valley Conservation Authority (Major) 3,000.00 (Minor) 700.00 Additional fees that may be required: Major Revision $1,886.00 Preparation of Agreement $1,687.00 Rescheduling fee deferred application $ 334.00 per application Certificate of Consent or Validation $ 404.00 per application 1.3 Drawing Submission Separation of units along party wall $ 500.00 each additional parcel 1 full size copy of a Surveyor s Sketch with a Key Map and 25 reduced copies, showing the following Prescribed Information: the boundaries and dimensions of the subject land, the part that is to be severed and the part that is to be retained; the boundaries and dimension of any land owned by the owner of the subject land and that abuts the subject land; the distance between the subject land and the nearest township lot line or landmark, such as a railway crossing or bridge; the location of all land previously severed from the parcel originally acquired by the current owner of the subject land; the approximate location of all natural and artificial features on the subject land and adjacent lands that in the opinion of the applicant may affect the application, such as buildings, railways, roads, watercourses, drainage ditches, river or stream banks, wetlands, wooded areas, wells and septic tanks; the existing use(s) on adjacent lands; such as residential, agricultural and commercial uses; 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; and the location and nature of any easement affecting the subject land. Details of easements or restrictive covenants affecting the lands to be severed should be shown on the sketch. The sketch of survey must be prepared by an Ontario Land Surveyor in metric. NOTE: Any full size maps are to be folded so as to fit into a legal sized folder. - 2 -

1.4 Owner s Authorization If using an Agent or Solicitor 1.5 Regional Municipality of Halton - Environmental site-screening Checklist * The Region of Halton Planning and Public Works Departments requires that the above noted form (attached) be completed and submitted with the consent application for NEW LOTS AND LOT ADDITIONS. 2. Procedures The procedure to process a Consent application is outlined as follows: a. Building Staff review the application for its completeness and accuracy. b. Building Staff prepare a circulation to other departments and agencies. c. A Notice of Application will be circulated (if applicable) or a Notice of Public Hearing as per the Planning Act regulations. d. A staff report will be submitted for the Director of Planning Services (if applicable) or consideration at a Committee of Adjustment meeting. e. These meetings typically take place the 2nd and 4th Tuesday of every month. f. Appeals may be made and will be forwarded to the Ontario Municipal Board and the Ontario Municipal Board may order a public hearing. 3. Signs The applicant is required to post a sign on the subject lands. The signs will be provided by the Town of Oakville and shall be placed on the subject property in a location that is visible from the public roadway. The Owner of the land should complete the required application form and, along with the necessary documents and fees, submit it to: Building Services Department Town of Oakville 1225 Trafalgar Road Oakville, ON L6H 0H3 NOTE Personal information on the following forms and any supporting documentation is collected under the authority of the Ontario Planning Act and will be used by the Building Services Department in the processing of the Committee of Adjustment application. The information may be used by other departments and agencies for the purpose of assessing the proposed consent. This information may also be released to the public. Questions about the collection of this information should be directed to: Director of Building Services Town of Oakville 1225 Trafalgar Road Oakville, ON L6H 0H3 Phone: (905) 845-6601 Ext. 3195 FURTHER INFORMATION REGARDING THE COMMITTEE OF ADJUSTMENT CAN BE OBTAINED FROM OUR WEBSITE: http://www.oakville.ca/residents/committee-of-adjustment.html - 3 -

CONSENT APPLICATION Building Services Department The Corporation of the Town of Oakville 1225 Trafalgar Road Oakville, ON L6H 0H3 Date Received: File #: LOCATION OF SUBJECT APPLICATION MUNICIPAL ADDRESS: POSTAL CODE: (contact Oakville Public Works if no address assigned) LAND LEGAL DESCRIPTION: LOT(S): CONCESSION(S): REGISTERED PLAN: 20M- BLOCK(S)/LOT(S): REFERENCE PLAN: 20R- PARCEL #: ROLL NUMBER: 2401 _ PART(S): Are there any easements or restrictive covenants affecting the subject land? No Yes If yes, describe it and its effect. OWNER OF THE SUBJECT SITE COMPANY NAME: CONTACT NAME(S): ADDRESS: CITY: POSTAL CODE: PHONE NO: ( ) FAX NO: ( ) E-mail: APPLICANT/AGENT (If Applicable) COMPANY NAME: CONTACT NAME(S): ADDRESS: CITY: POSTAL CODE: PHONE NO: ( ) FAX NO: ( ) E-mail: MORTAGEES, HOLDERS OF CHARGES OR OTHER ENCUMBRANCES COMPANY NAME OR INDIVIDUAL(S) NAME: ADDRESS: CITY: POSTAL CODE: PHONE NO: ( ) FAX NO: ( ) SOLICITOR COMPANY NAME: CONTACT NAME(S): ADDRESS: CITY: POSTAL CODE: PHONE NO: ( ) FAX NO: ( ) E-mail: NOTE: Please allow 90 days for processing of the Consent application. - 4 -

APPLICANT TO COMPLETE THE FOLLOWING AND SUBMIT WITH THE APPLICATION 1. APPLICANT S NAME: 2. SITE LOCATION: 3. PURPOSE OF THIS APPLICATION: 3.1 Purpose of proposed transaction (Provide a brief summary next to the appropriate box of what is proposed, including land use.) New Lot(s) A Mortgage or Partial Discharge of Mortgage Lot Addition ** Title Correction Easement or Right of Way Other (specify) A Lease Purpose ** We require legal confirmation of how the lot, that the severed portion is being added to, was created because of Section 50(12), and identify the lands to which the parcel will be added. 3.2 Name of person(s) (purchaser, lessee, mortgagee) to whom land or interest in land is intended to be conveyed, leased or mortgaged (if known). 4. HISTORY OF THE SUBJECT LAND: 4.1 Has the subject land ever been the subject of an application of a plan of subdivision or consent under the Planning Act: No Yes Unknown If yes, please give File # & decision 4.2 Is this a resubmission of an earlier proposal? Yes No If yes, please give File # & decision - 5 -

4.3 Has any land been severed from the parcel originally acquired by the owner of the subject land? Yes No If yes, provide for each parcel severed the date of transfer, the name of the transferee, and the land use: 4.4 Date Owner acquired the subject land 5. DESCRIPTION OF SUBJECT LAND AND SERVICING INFORMATION: 5.1 Description of Property as shown on Sketch Severed Retained Frontage (m) as per zoning by-law Frontage (m) at street limit Depth (m) Area (ha) 5.2 Use of Property (select from list) Urban Residential Agricultural Farm Related Residential Non Farm Related Residential Other (specify) Complete a Farm Data Sheet for any Agricultural use on severed and/or retained parcel. Farm Data Sheet Severed Retained Existing Use Proposed Use * If Agricultural, indicate whether parcel is for: a) Disposal of Surplus Dwelling c) Farm Help - 6 -

5.3 Buildings or Structures (Please indicate number of uses and dates of construction) Severed Retained Existing Proposed 5.4 Road Access Severed Retained Open Municipal Road Regional Road Provincial Highway Private Other Access (Specify) e.g. Water, Right-of-Way (explain) Type/Name Severed Retained 5.5 Water Supply Severed Retained Regional Piped Water Well Other (e.g. communal) 5.6 Servicing - Sewage Disposal Severed Retained Regional Sewers Septic System Other (Specify) 6. LAND USE: 6.1 What is the existing Regional Official Plan Designation? 6.2 What is the existing Local Official Plan Designation? - 7 -

6.3 What is the existing Zoning Designation of the subject lands under the Town of Oakville Consolidated By-law 1984-63 (as amended) 2009-189 (as amended) General By-law Designation: Site Specific By-law (s): 6.4 Are any of the following uses or features on the subject land, or within 500 metres of the subject land, unless otherwise specified? Use or Feature Agricultural, including livestock facility or stockyard Landfill Sewage treatment plant or waste stabilization plant Provincially significant wetland within 120 m of site Floodplain Industrial or commercial use Active railway line On the Subject Land Within 500m of Subject Land 6.5 Potentially Contaminated Sites: 6.5.1 Has there been industrial use of the site? Yes No If yes, last year of use 6.5.2 Has there been filling on the site? Yes No 6.5.3 Is there reason to believe the site may have been contaminated by former uses either on the site or on adjacent sites? Yes No If yes, then an environmental investigation including all former uses of the site and, if appropriate, the adjacent site to the satisfaction of the Town is required. This study must be by a qualified consultant. Report attached? Yes No If no, on what basis did you come to this determination? 6.5.4 Has the Regional Municipality of Halton Environmental Site-Screening Checklist been completed and submitted with this application? Yes No PLEASE NOTE: Personal information collected on this application will become part of a public record. Information may be divulged as required by the Planning Act, 1990 as amended, or upon request under The Municipal Freedom of Information and Protection of Privacy Act, 1989. - 8 -

A F F I D A V I T I hereby authorize the members of the Town of Oakville Committee of Adjustment, members of the staff of the Town of Oakville and circulated agencies to enter upon the subject lands and premises for the limited purpose of evaluating the merits of this application. I, of the (owner, applicant, agent) (town, city) of in the (region, county) of SOLEMNLY DECLARE THAT: All of the above statements outlined in this application are true, and I make this solemn declaration conscientiously believing it to be true and knowing that it is the same force and effect as if made under oath, and by virtue of the Canada Evidence Act. Declared before me at the of in the (town, city) of this (region, county) day of A.D. 20. A COMMISSIONER, ETC. SIGNATURE OF OWNER OR AUTHORIZED AGENT Owner s Authorization If an agent is used, the owner must also complete the following. If the owner is an incorporated company, the signature should be accompanied by the corporate seal. I, being the registered owner of the (name of owner, individual or company) subject land, hereby authorize to prepare and submit (name of agent) and act on my behalf with respect to this consent application. (Signature) Day Month Year O:Consent Applications/consent application forms/ Master Consent Application February 2012.DOC - 9 -

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