Applicant Information

Property Owner:

Phone or Cell:

Email Address:

Tax Roll Number:

Address:

Road Name (with which driveway intersects):

Legal Description of Property Requiring 9-1-1 signage:

Concessions:

Lot:

Part:

Plan:

Building Permit Number:

    There is a fee of One hundred dollars ($100) to cover the cost of the supply of civic addressing signage. This fee must be included with this application. A fee of thirty dollars ($30) will be charged for any cheque returned NSF.

Signature:

To determine a civic address, a distance measurement is taken to the centre of the driveway; therefore, the driveway MUST be in and should be marked.

Please attach a copy of the Municipal entrance permit if applicable.

Payment Method of application fee. Payable to: Municipality of St.-Charles
CashChequeMoney Ordere-Transfer([email protected])