Application for City of Mississauga Access Modification ...

Application for Access Modification

Road Resurfacing

Personal Information on this form is collected pursuant to Section 286 (c) of the Municipal Act 2001, SO 2001, c.25 and City policy 04-05-02, and will be used for the purposes of administering City of Mississauga By-Law 487-78, as amended.

City of Mississauga Transportation and Works Department Customer Service Counter 3185 Mavis Road, 1st Floor Mississauga ON L5C 1T7 Tel: 905-615-4950 Fax: 905-615-3172 Email: tw.counter@mississauga.ca

Address of Work Site City MISSISSAUGA

Postal Code

Is the applicant's address same as work site address?

Applicant's Name Applicant's address if different from work site

City

Postal Code

Phone#1

Phone#2

Email

Please Note: This application must be submitted to the Transportation and Works Customer Service Counter within two business days of receiving the Road Resurfacing Program Notice. LATE SUBMISSIONS WILL NOT BE ACCEPTED. Administrative Fee is non- refundable. For technical questions, contact the Traffic Operations Section at (905) 615-3200 ext. 4808 prior to submitting the application.

CURB CUT - See drawing below (all measurements must be in metres)

Existing Driveway Width (m)

New Driveway Width (m)

Existing Curb Cut (m)

New Curb Cut left (m)

New Curb Cut Right (m)

For office use only PERMIT NUMBER:

Last Modified: March 2016

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