Enquiry Referral Form

CLEAN WATER ACT PART IV SECTION 59 ENQUIRY REFERRAL FORM

Are you proposing new activities or a change of activities (under the Planning Act or Building Code) within a vulnerable area surrounding a municipal drinking water system? This includes construction or the change of use of a property or business.

To see if your proposal is in the affected vulnerable areas check the Policy Information Maps.

Some activities may require a risk management plan or may even be prohibited.

A risk management official will respond promptly to your enquiry, usually within two business days.

Please Note: Personal information collected on this form will be kept on file and used by Quinte Conservation to process this enquiry. This information may also be shared with: the municipality in which the subject property is located and; the Province of Ontario, for the purpose of protecting drinking water sources as per the Clean Water Act, 2006 of Ontario. Personal Information collected on this form is protected under the Municipal Freedom of Information and Protection of Privacy Act.


1.0 General Information

Name (Owner and Tenant or Contractor required)

Property Address:

Phone (required):

Cell:

Your Email (required):

Municipality:

Fax:

Lot/Con:

Roll #:

Drinking Water System:

Vulnerable Area (please check quintesourcewater.ca or ask municipality if unsure):

Mailing Address(if different from property address above)


2.0 Application Type (check all that apply):

Land Use


3.0 Land Use:

Present Land Use

Proposed Land Use


4.0 Proposed Activity:

(Please provide description of activity. Example: Renovation for home business – garage for automotive repairs. provide details)