Drain Improvement Request or New Drain Petition Supplement

Please note this form is intended to be printed, filled out and mailed. Currently, no method is provided for electronic submission.
(to be used with form 3 of Drainage Act Regulation 274)

Section A (To be completed by a Landowner) -- Please Print

Contact Person: _______________________________________________

Telephone: ___________________________________________________

1. Location of Project:

   Lot: _______________________________________________________

   Concession: ________________________________________________
   
   Municipality: ________________________________________________
   
   Former Municipality (if applicable): ____________________________________________________
   
   Civic Address (number & road name): __________________________________________________

2. What Work Do You Require? (check all appropriate boxes):
   
   [  ] Construction of a new open channel
   [  ] Realignment of an existing open drain
   [  ] Replacement of an existing tile municipal drain
   [  ] Deepening or widening of an existing watercourse (not currently a municipal drain)
   [  ] Deepening or widening of an existing municipal drain
   [  ] Construction of a new tile drain
   [  ] Closing in of an existing open channel
   [  ] New or replacement drain crossing
   [  ] Other (provide description)
   
   
3. Name of Drain/Watercourse (if known) _________________________________________________
   
   
4. Approximate length of the project _____________________________________________________
   
   
5. General description of the soils in the area ______________________________________________
   
   
6. What is the Purpose of the Proposed work?(check appropriate box)

   [  ] Tile drainage only
   [  ] Surface water only
   [  ] Both

Section B (To be completed by Municipal Representative) -- Please Print

Please review the information shown in Section A and make any necessary corrections.

1. Contact Person: __________________________________________
   Telephone: _____________________________________________
   
   
2. Drain Project Authorization: [  ] Section 4
                                            [  ] Section 78
   
   
3. Name of Receiving Drain/Watercourse: _________________________________________________
   
4. Work and Impact Zone Information:
   

5. What significant features are located along or adjacent to the watercourse?drain? E.g. wetlands, ANSI's, upland forest, gravel pits, other features.
   
   __________________________________________________________________

   __________________________________________________________________

   __________________________________________________________________
   

6. Is there anything else about this proposed project of which the engineer or review agencies should be aware? E.g. poor soils, buried utilities, structures encroaching on the drain/watercourse, etc.
   
   ___________________________________________________________________

   ___________________________________________________________________

   ____________________________________________________________________

   Include a copy of a drain plan or area map with this information.