Town of Essex Entrance Application

Before signing off on this application, you must read through the conditions and specs/dimensions that must be followed at:

Permit Number:

Date of Approval:

Street No. and Street Name:

Additional Location Information (ie. nearest intersection or lot number):

Please Describe Work:

Proposed Work Start Date:

Proposed Work End Date:

Impact to Road:

Daily Closure

Continuous Closure

Other

Name (Last, First)

Company Name (if applicable)

Full Mailing Address

Phone Number

Cell Phone Number

Email Address

Upload Supporting Plan/Drawing Documents:

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Applicant Signature:

Clear

Date:

Application Checklist:

Plan/drawings detailing location and extent of proposed works

Applicable Permit Fee & Deposit (Cheque made payable to the Corporation of the Town of Essex)