2.
Contact Information
Mailing Address
Telephone
Facsimile
E-mail
Owner
(
)
(
)
Applicant
(
)
(
)
Agent or Primary
(
)
(
)
Consultant
Other: (specify)
Correspondence relating to this application should be sent to (select
The applicant is:
one only):
Owner
Applicant
Agent or
Other
Owner
Lessee of Land or
Prospective
Primary
Tenant
Owner
Consultant
If the applicant is not the Owner, the Owner must consent to the
proposed application for Minor Variance to the Town’s of Ajax Sign
By-law
Owner’s Signature:
Separate Letter of Authorization attached
Date:
2.
Details of Application
Municipal Address
Lot/Part #
Plan/Concession #
Assessment Roll # & PIN #
Description of Proposed Sign
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Page 2 of 3
FORM: PLD-032
REVISED: 11/11/28