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APPLICATION FOR EXEMPTION FROM PART LOT CONTROL The Corporation of the Town of Whitby 575 Rossland Road East, Whitby Ontario, L1N 2M8 Telephone: 905.430.4306 ~ Facsimile: 905.668.7812 PLEASE READ THE ENTIRE APPLICATION FORM PRIOR TO COMPLETING GENERAL INFORMATION AND PROCEDURES The attached application is to be used by persons or public bodies as an application for exemption from Part Lot Control. In the application, "subject land(s)" means the land(s) that is the subject of this application. This application and any attached supporting documentation contains information collected and maintained specifically for the purpose of creating a record available to the general public and is open to inspection by any person during normal office hours. Personal information on this application is collected under the authority of the Municipal Act, as amended, and the Planning Act, as amended, and will be used for the purposes of processing this application. Questions regarding this collection should be directed to The Corporation of the Town of Whitby, Access and Policy Coordinator, 575 Rossland Road East, Whitby, Ontario, L1N 2M8 905.430.4315. Purpose: Where land is within a registered plan of subdivision and the owner wishes to subdivide a lot or a block within such registered plan for the purpose of selling, conveying, leasing or mortgaging such part lots or part blocks, an owner may request the Town to pass a Part Lot Control Exemption By-law under Section 50(7) of the Planning Act. This provision establishes that subsection 5 (Part Lot Control) does not apply to land that is contained within the lands subject to a Part Lot Control by-law. The Town uses this provision as a means of preventing the possible uncontrolled division of lots within a plan of subdivision after the plan has been registered. Submission of Application: Pre-consultation prior to submission of an application is encouraged. Applicants are required to provide 6 copies of a draft reference plan prepared by an Ontario Land Surveyor, showing all existing proposed easements, lot lines, location, dimensions and setbacks to all buildings or foundations and accessory structures and all other appropriate measurements. The completed application is to be submitted to: Fees: Town of Whitby Planning and Development Department 575 Rossland Road East Whitby, Ontario L1N 2M8 (Telephone: 905.430.4306 ~ Fax: 905.668.7812) All fees, as detailed in the application, must be submitted with the completed application. Procedure: Following evaluation of the proposal and internal comments, a by-law exempting the proposal from Part Lot Control will be forwarded to Council for adoption. Town staff register the by-law on title and notify the applicant of registration. PLC Info Revised April 2015

APPLICATION FOR EXEMPTION FROM PART LOT CONTROL The Corporation of the Town of Whitby 575 Rossland Road East, Whitby Ontario, L1N 2M8 Telephone: 905.430.4306 ~ Facsimile: 905.668.7812 SHADED AREAS FOR OFFICE USE ONLY File.: Date Entered in AMANDA: Entered By (Initials): By-law: 1784 2585 5581-05 With Zoning Amendment With Major Redline Revision Date Received: With Removal of H Holding With Redline Revision PART I APPLICANT INFORMATION 1. Owner / Applicant / Agent: Please list the contact information for the each of the following (if applicable): Name Mailing Address & Postal Code Contact Information Owner:* Telephone: Applicant:** Agent or Solicitor:** Fax: Email: Telephone: Fax: Email: Telephone: Fax: Email: * If there is more than one owner, attach a list of each owner. If the owner is a company, provide the name and address of company owner(s). **An Owner s authorization is required if the applicant is not the owner. If the applicant is a prospective purchaser, also attach a copy of the Offer to Purchase. 2. Primary Contact: Correspondence relating to this application should be sent to (select one only): Owner Applicant Agent / Solicitor PART II PROPERTY INFORMATION 3. Property Information: Location and Description of Subject Land(s): Municipal Address (Street # and Street Name) Assessment Roll # Registered Plan(s) Lot(s) / Block(s) # Reference Plan(s) Part(s) #

Application for Exemption from Part Lot Control Page 2 of 9 Lot(s) Concession(s) Approximate Area (hectares) 4. Easements / Encumbrances / Mortgages: 4.1 Are there any easements, rights-of-way, restrictive covenants, etc., affecting the subject land(s)? If, please identify below, and indicate on a site plan, the nature and location of the easement, right-of-way, restrictive covenant, etc: 4.2 Are there any mortgagees, holders of charges or other encumbrances? If, please list the names and addresses of the mortgagees, holders of charges or other encumbrances: PART III DETAILS OF APPLICATION 5. Official Plan: What is the current Town of Whitby Official Plan designation, and if applicable, Secondary Plan designation of the subject land(s)? 6. Zoning By-law: By-law: What is the current zone category(s) of the subject land(s)? 1784 2585 5581-05 7. Previous, Current & Proposed Land Uses: 7.1 What was the previous use of the subject land(s)?

Application for Exemption from Part Lot Control Page 3 of 9 7.2 Date of acquisition of subject land(s): 7.3 Existing use(s) of the subject land(s): 7.4 Length of time the existing uses of the subject land(s) have continued: 7.5 Date of construction of all buildings and structures on subject land(s): 7.6 Proposed use(s) of the subject land: 8. Details of the Request for Removal from Part Lot Control: 8.1 What is the reason for requesting removal of Part Lot Control (e.g. to create a new lot; to create a lot addition; to split an attached structure)? 8.2 Nature of request: Proposed Use Type of building / structure Number Residential Single detached dwellings Semi-detached dwellings Townhouse dwellings Apartments or Other Total Dwelling Units Industrial Commercial Other Describe: Describe: Describe:

Application for Exemption from Part Lot Control Page 4 of 9 8.3 Does the owner have an interest in nearby or adjoining lands? If, please indicate the location and area of nearby or adjoining lands in which the owner has an interest: 9. Plans: A key map, a draft legal plan of survey (40R- plan), and a registered plan (40M- plan) which illustrate the land(s) subject to the application for removal of part lot control must be submitted with the application. (All dimensions are to be in metric units.) Are the key map, draft legal plan(s) of survey and registered plan(s) attached? 10. Other Applications: 10.1 Has the subject land(s) ever been subject of a previous application under the Planning Act? If, please specify (i.e. Applicant, File.(s), year, status, effect): 10.2 Please indicate if the applicant or owner is also submitting any of the following applications under the Planning Act for the subject land(s): Other Applications Durham Regional Official Plan Amendment Whitby Official Plan Amendment Plan of Subdivision Zoning By-law Amendment Consent to Sever Site Plan Approval Minor Variance Minister s Zoning Order Subject Lands If was answered to any of the questions above, the Other Applications Table must be completed. 11. Site Screening Questionnaire: The attached Site Screening Questionnaire for identifying potentially contaminated sites must be completed and submitted with the completed application. Is the attached Site Screening Questionnaire completed?

Application for Exemption from Part Lot Control Page 5 of 9 PART IV SUBMISSION OF APPLICATION 12. Fees: Town of Whitby (Fees effective September 1, 2017; subject to change without prior notice) A non-refundable application fee of $376.91 for each new unit/lot/block, paid by cash, debit card or cheque made payable to the Treasurer of the Town of Whitby. 13. Forms, Information and Materials: One (1) original copy of the completed application form One (1) original covering letter outlining the nature of the requested Removal of Part Lot Control One (1) copy of a site location map, or key map, in 8½ x 11 format One (1) copy of the proposed Building Siting Plan for any proposed semi-detached and/or townhouse dwelling lots proposed for Part Lot Control One (1) copy of a draft Reference Plan (40R- Plan), with a Surveyors Frontage and Area Certificate (All dimensions are to be in metric.) One (1) reduced copy, on 8½ x 11 sheet of paper, of the Reference Plan (40R-Plan) One (1) copies of the Registered Plan (40M-Plan) with the proposed area for Removal of Part Lot Control clearly highlighted (All dimensions are to be in metric.) One (1) reduced copy, on 8½ x 11 sheet of paper, of the Registered Plan (40M-Plan) with the proposed area for Removal of Part Lot Control clearly highlighted One (1) digital version of the plan(s) in.dwg format (correctly geo-referenced in rth American Datum 1983 (NAD83) Zone 17 rth Projection and using UTM grid bearing reference Owner s Authorization, if applicable Completed and signed Other Applications Table Completed and signed Site Screening Questionnaire 14. Applicant s Acknowledgements: The Applicant hereby acknowledges: that this application and the attached supporting documentation, information and materials, if any, contains information collected and maintained specifically for the purpose of creating a record available to the general public and is open to inspection by any person during normal office hours pursuant to the provisions of the Municipal Freedom of Information and Protection of Privacy Act that personal information on this application is collected under the authority of the Municipal Act, as amended, and the Planning Act, as amended, and will be used for the purpose of processing the application and to determine compliance with the policies and by-laws of the Town of Whitby that conceptual development plans and/or drawings submitted with this application are not reviewed for compliance with the Ontario Building Code (O.B.C.) and/or related regulations that submission of this application constitutes tacit consent for authorized Town staff representative(s) to inspect the subject lands or premises, and to carry out any inspections, tests and investigations as may be required that all vegetation on the subject land(s) must be maintained and no filling, grading or excavating is permitted on the subject land(s) during the processing of this application that additional approvals from the Town and/or other agencies (e.g. building permit, site plan approval, CLOCA permit) may be required that additional fees and/or charges (e.g. building permit fees, parkland dedication fees, development charges) associated with any development approved in conjunction with this application may be required that the applicant will be required to pay reasonable legal fees of the Town for the preparation and registration of agreements when such agreements are required that additional information and/or materials may be required, and therefore, the application may not be deemed complete, nor processed unless the additional information and/or materials are submitted. Questions about the collection and inspection of this information should be directed to: Commissioner of Planning, Town of Whitby, 575 Rossland Road East, Whitby, Ontario, L1N 2M8, Telephone: 905.430.4306.

Application for Exemption from Part Lot Control Page 6 of 9 15. Owner s Authorization: If the applicant is not the owner of the land that is the subject of this application, then written authorization by the owner, authorizing the applicant to prepare and submit the application must be attached, or the owner must complete the authorization set out below. Is written authorization attached? If, then the following Owner s Authorization for the Agent to prepare and submit the Application must be completed: I,, am the owner of the land that is the subject of this application and (Please print) I authorize to prepare and submit this application on my behalf. (Please print) Signature of Owner Date 16. Declaration: I,, of the, (Please print) (e.g. Town of Whitby) in the, make oath and say (or solemnly (e.g. Region of Durham) 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 the Sections above is true. Sworn (or declared) before me at the, in the (e.g. Town of Whitby), this day of, in the year. (e.g. Region of Durham) Applicant Commissioner of Oaths Applications will not be processed where application forms and/or fees are incomplete

Application for Exemption from Part Lot Control Page 7 of 9 OTHER APPLICATIONS If there are other applications for the subject lands the table below must be completed and submitted with the completed application form. Other Applications Durham Regional Official Plan Amendment Plan of Subdivision / Condominium Zoning By-law Amendment File. Approval Authority Subject Land(s) Lands Affected Purpose of Application Effect of Application Status of the Application Consent to Sever Site Plan Approval Minor Variance Minister s Zoning Order Other (Describe) Prepared By: Name: Signature: (Please Print) Date:

Application for Exemption from Part Lot Control Page 8 of 9 SITE SCREENING QUESTIONNAIRE This form must be completed and submitted with the attached development application, unless a Phase 1 Environmental Site Assessment, prepared in accordance with the Provincial Guideline for Use at Contaminated Sites in Ontario, is provided. Although a consulting engineer can and should assist in the preparation and completion of the form, the Registered Owner of the subject land(s) must sign this form. Location of Subject Land(s): Municipal Address (Street # & Street Name) Assessment Roll # Registered Plan(s) Lot(s) / Block(s) # Reference Plan(s) Part(s) # Lot(s) Concession(s) Approximate Area (hectares) 1. Was the subject land(s) or adjacent land(s) used for Industrial Uses where there is a potential for site contamination? 2. Was the subject land(s) or adjacent land(s) used for Commercial Uses where there is a potential for site contamination? 3. Has filling occurred on the subject land(s) or adjacent land(s)? 4. Was the subject land(s) or adjacent land(s) used for aboveground / underground storage tanks or for buried waste? 5. Was the subject land(s) or adjacent land(s) used for Agricultural Uses where potentially toxic chemical products may have been used as pesticides? 6. Was the subject land(s) or adjacent land(s) used as a weapons firing range? 7. Are the boundaries of the subject land(s) within 500 metres (1,640 feet) of the fill area of an operating or former landfill? 8. If there are any existing or previously existing building(s) on the subject land(s), are there any building materials remaining on site, which are potentially hazardous to public health? 9. Is there any reason to believe that the lands may have been contaminated based on a previous land use on the subject land(s) or adjacent land(s)? 10. What information was used to determine the answers to Questions 1 to 9? If the answer to any of Questions 1 to 9 is, then a Phase 1 Environmental Site Assessment (ESA), in accordance with the Ministry of Environment s Guideline for Use at Contaminated Site in Ontario, is required. Please submit seven (7) copies with the completed application. Has a Phase 1 ESA report been prepared for the subject land(s) or adjacent land(s)? If, is the Phase 1 ESA report attached?

Application for Exemption from Part Lot Control Page 9 of 9 SITE SCREENING QUESTIONNAIRE Declaration: This form must be completed and signed by the Registered Owner as well as and signed and stamped by a Professional Engineer. Consulting Engineer Name of Consulting Engineer (please print) Signature of Registered Owner Date Name of Company: Telephone Fax: Address & Postal Code Registered Owner (or Authorized Officer) I,, am the registered owner of the land(s) that is subject of an (please print) application under the Planning Act and to the best of my knowledge, the information provided in this questionnaire is true. I agree for the purposes of the Municipal Freedom of Information and Protection of Privacy Act, 1989, to authorize and consent to the use by or the disclosure to any person or public body of any personal information that is collected under the authority of the Planning Act for the purposes of processing this application. Sworn (or declared) before me at the in the (e.g. Town of Whitby), this day of, in the year (e.g. Region of Region) Name of Registered Owner (please print) Signature of Registered Owner Commissioner of Oaths Date PLCA Revised September 2017