CULVERT/BRIDGE REPAIR/REPLACEMENT
Conservation Authority: Choose an item.	Fee: Fee	File number: File Number
Acting Agent: Click here to enter text.	Company Name: Click here to enter text.
Phone#: Phone	Fax#: Fax	Email: Email
Municipality: Choose an item.
Contact Name: Click here to enter text.
Mailing Address: Click here to enter text.
Phone#: Phone	Fax#: Fax	Email: Email
Drain Name: (as referred to under the Drainage Act) Click here to enter text.	Bridge Name: Click here to enter text.
Proposed work: Choose an item. Other: Click here to enter text.
Location:	Lot: Lot	Conc: Concession	Twp: Township
Existing Structure Type: Choose an item.
Slope of Culvert: Click here to enter text.	Flow Rate Expected to: Choose an item.
Existing Length: Click here to enter text.	Existing Diameter/Span: Click here to enter text.
Existing Hydraulic Capacity: Click here to enter text.	Existing Flow Pattern: Click here to enter text.
Proposed Length: Click here to enter text.	Proposed Diameter/Span: Click here to enter text.
Proposed Hydraulic Capacity: Click here to enter text.	Proposed Flow Pattern (please specify details): Click here to enter text.
Proposed Structure Type: Choose an item.
End Treatment: Choose an item. Other: Click here to enter text.
Method of Isolation: Choose an item. Other: Click here to enter text.
Other proposed work: Click here to enter text.
Sediment & Erosion control methods to be used: Choose an item. Click here to enter text.
Site Restoration proposed: Click here to enter text.
Comments on any flood or erosion issues: Click here to enter text.
Is the Culvert/Bridge Repair/Replacement for residential access? : ☐ Yes ☐ No If yes, design standard? : Click here to enter text.
Dated photos of upstream/downstream of opening: ☐ Yes ☐ No (if yes, please attach)
Dates of Proposed Work:	START	Day:	Day	Month:	Month	Year:	Year
FINISH	Day:	Day	Month:	Month	Year:	Year
Other Considerations for Review Agencies (Please specify): Click here to enter text.
The above mentioned work has been reviewed with respect to the Conservation Authorities Act. After reviewing our files & mapping, it has been determined that the proposed work is subject to the Authority's Alterations to Watercourses portion of the Regulation. The issue of concern within this area is the proposed works to the waterway. If the proposed work is carried out as described in the plans provided to the Conservation Authority, & with the conditions listed below, the Authority will have no objections to the proposed work with respect to the Conservation Authorities Act. Your permission is valid for a period of 24 months after it has been approved. Please refer to the project specific requirements listed below:
Work to be conducted during low to no flow conditions & timed to avoid large precipitation seasonal runoff events. That accumulated sediment be removed from the fence prior to the removal of the fence. That debris be stockpiled well away from the drain & stabilized, with appropriate sediment control, then levelled & seeded as soon as possible. Any stone rip-rap protection on the bed/banks & end treatment to be embedded to bed/bank level to prevent washouts &/or debris hang-ups on the materials. Ensure that the culvert & bottom erosion control protection material are embedded a minimum if 10-15% to maintain the existing stream bed gradient. All healthy trees on top of the bank & outside of the work area to be maintained where possible except where access to the site is required by construction activities.

All healthy trees on top of the bank & outside of the work area to be maintained where possible except where access to the site is required by construction activities. All activities, including maintenance procedures, must be controlled to prevent the entry of petroleum products, debris, rubble, concrete or other deleterious substances into the water.Vehicular refuelling & maintenance must be conducted away from the water. That construction be underway prior to the permit lapsing. This letter of advice does not release you from the responsibility to obtain any other federal, provincial, territorial, or municipal approvals that may be required. Approvals may be required from other agencies prior to undertaking the work proposed. The Conservation Authority does not exempt the applicant from complying with any or all other approvals, laws, statutes, or regulations. Permission granted by the Conservation Authority cannot be transferred without prior written approval from the Conservation Authority. The Conservation Authority may at any time withdraw any permission given if, in the opinion of the Conservation Authority, the representations contained in the application for permission are not carried out or the conditions/requirements of the permit are not complied with, or site conditions have changed/altered since the time of the application’s approval. Authorized representatives of the Conservation Authority may at any time enter onto the lands that are described herein, in order to make any surveys, examinations, investigations or inspections that are required for the purpose of insuring that the work(s) authorized by this permit are being carried out according to the terms of this permit. The Owner & Applicant agree: To indemnify & save harmless the Conservation Authority & its officers, employees, or agents from & against all damage, loss, costs, claims, demands, actions & proceedings, arising out of or resulting from any act or omission of the Owner &/or Applicant or any of their agents, employees or contractors relating to any of the particulars, terms or conditions of this permit; That this permit shall not release the Applicant from any legal liability or obligation & remains in force subject to all limitations, requirements & liabilities imposed by law; That all complaints arising from the execution of the works authorized under this permit shall be reported immediately by the Applicant to the Conservation Authority. The Applicant shall indicate any action that has been taken, or is planned to be taken, with regard to each complaint. The project shall be carried out in full accordance with the plans submitted in support of the application. Strict sediment & erosion control measures implemented prior to, & maintained throughout the duration of construction phase, including in-channel sediment & erosion control measures. The sediment & erosion control measures are to be left in place until all disturbed areas have stabilized, & to be inspected daily by the contractor. All disturbed areas shall be seeded, sodded, or stabilized in some other manner acceptable to the Conservation Authority as soon as possible, & prior to the expiry of this permit, & applicant agrees to maintain all sedimentation controls until all disturbed areas have been stabilized. The Applicant agrees to maintain all existing drainage patterns, & not to obstruct external drainage from other adjacent private lands. Include dated photos upstream & downstream of opening if applicable.
Project Specific Conditions: Click here to enter text.
Note: The information on this form is being collected for the purposes of administering a regulation made pursuant to Section 28, Conservation Authorities Act, R.S.O. 1990, Chapter, 27. This application & supporting documents & any other documentation received relating to this application, may be released, in whole or in part, to other persons in accordance with the Municipal Freedom of Information & Protection of Privacy Act, R.S.O. 1990c. M.56, as amended.
I, the undersigned, representing the above named municipality, hereby declare my intention to carry out the works or undertakings described above in the classified drain. Furthermore, I request that I be provided with the appropriate authorizations under the Fisheries Act, Conservation Authorities Act, or Endangered Species Act for the proposed work. I will carry out all activities relating to the project within the designated time frames & conditions as specified in the authorizations provided.
Signature of acting agent:	Date:
Conservation Authority Signature:	Date: