Authorizing Access Onto and Through Municipal Property and Parklands

Notice of Collection of Personal Information

Personal information on this form is collected under the legal authority of Municipal Act, 2001. The  delegate’s information is collected and maintained for the purpose of creating a record that is available to the general public, pursuant to Section 27 of the Municipal Freedom of Information and Protection of Privacy Act. This information is collected and maintained for the purposes of preparing an agenda for Council. Questions or concerns about the collection of this information can be directed to the Clerk at 4305 Hamilton Road, Dorchester ON N0L 1G3, Phone: 519-268-7334 ext 254 or clerk@thamescentre.on.ca 

We, the undersigned applicants, agree and bind ourselves to indemnify and save harmless the Municipality of Thames Centre from any and all claims arising as a result of the work for which this Permit is issued.

1. THAT we will indemnify and save harmless the Municipality from claims from either the travelling public or the private property owners, arising out of or as a result of the work for which the permit is requested.
2. THAT the applicant is obligated to see that no existing cables conduits structures, or other appurtenances are interfered with. The Municipality does not guarantee that the location chosen is not in use by other utilities or services.
3. THAT the Foreman in direct charge of the work will, at any time during progress of the work, advise the number of the permit for the work involved, when so requested by any Municipal employee.
4. THAT we will restore the road to its original condition promptly.
5. THAT all property shall be kept clear of lumber, sod, bricks, paving stone, gravel, mud or any other material pertaining to this job. Failure to remove material from the property after notice is given by the Municipality can result in cost of removal deducted from your deposit.
6. THAT the public will be properly safeguarded at all times.
7. THAT we will abide by the Occupational Health and Safety Act as set out in Ontario regulation 213/91 and any amendments thereto.
8. THAT we will assume responsibility for seeing that any maintenance required thereafter as a result of the work will be promptly attended to at our expense as soon as such maintenance is needed.
9. THAT upon failure to make such necessary repairs within 48 hours of such repairs becoming necessary, it is understood that the Municipality reserves the right to take such steps as it deems necessary to correct the condition and deduct the cost of such repairs.
10. THAT it is further understood that the Municipality will refund to the applicant any residual deposit still credited to the applicant, following request by the applicant for such refund, provided that the conditions of the permit have been complied with and a successful inspection of the property by the Municipality has been completed.

Authorization is hereby granted to the applicant and/ or his agents to perform the above described work subject to the General Conditions named in the Application and subject to the following additional specific conditions. By beginning the work on the road allowance, the Applicant( s) agree and bind themselves to ALL conditions on this Permit.