Required fields are marked with asterisks (*)

Development Services Building & Septic Division
180 Kent Street West
Lindsay ON K9V 2Y6
Telelephone: 705-324-9411 extension 1288
Email: buildingpermits@kawarthalakes.ca

A PDF of the completed form will be emailed to the applicant. Save and upload the completed form to the required permit application portal.

Building and Septic Owner Authorization

Please provide an answer to each of the following questions.

Legal owner(s) is authorizing another party to obtain a Building Permit on their behalf

Yes

Legal owner(s) is authorizing another party to obtain a Sewage System Permit on their behalf

Yes

Legal owner(s) is authorizing another party to obtain copies of information contained in an existing Building/Sewage System Permit, specifically: (owner must clearly specify which portions of the permit file are being released to the third party)

Yes

Specific information third party is allowed to obtain (ex. copy of permit drawings, inspection reports, etc.)

Current Property Owner:

Name of Authorized Agent:

Assessment Roll Number:

Municipal Address:

Lot:

Concession:

Plan:

Sublot/Part:

Email Address of Authorized Agent:

I/we, being the above noted legal owner(s) of the property described as above, in the City of Kawartha Lakes, certify that the above noted authorized agent is authorized, as indicated above, to act as my/our representative. Further, if this authorization applies to obtaining of a permit, to act as my/our representative for any associated site inspections. If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership.

I/we certify that all information and material provided for the purpose of this application is accurate.

Date:

Print Owner Name:

Owner Signature:

Clear

Date:

Print Agent Name:

Agent Signature:

Clear

Personal information contained on this form is collected pursuant to the Municipal Act, 2001 and will be used for the purpose of responding to your request. Questions about the collection of this information should be directed to the City Clerk or Deputy-Clerk at clerks@kawarthalakes.ca.