Required fields are marked with asterisks (*)

On Street Patio Application Form

Please complete this form, attach all required information.

APPLICANT INFORMATION

Name of Applicant/Business:

Contact Name:

Mailing Address:

Address of Business (if different from mailing address):

Postal Code

Phone No.

Email address:

PROPERTY OWNER INFORMATION
If applicant is property owner, please proceed to next section.

Name of Building Owner:

Mailing Address:

Postal Code:

Phone No.:

Email Address:

Proposed Date of Installation

Every application for an On-Street Patio permit shall:

be submitted annually in the form prescribed by the Clerk at least 30 days prior to the intended installation date (completing this application form);
be accompanied by the required administration fee as per the current Municipality of Kincardine Rates and Fees By-law;
be accompanied by a photograph of the intended site location (attach below);
be accompanied by proof of insurance as described in Section 9 of By-law No. 2021 - 069 (attach below);
be accompanied by an On-Street Patio Site Plan in accordance with the provisions of Schedule “A” of By-law No. 2021 - 069;
be accompanied by a completed Accessibility Checklist, Schedule “B” of By-law No. 2021 - 069 (attach below);
be signed by the applicant who shall certify as to the truth of the contents of the application;
be accompanied by any documentation required in section 4.1 of By-law No. 2021 - 069 (attach any related documentation below).

Does your proposed location meet one of the following criteria (check all that apply):

Where it would cover a water shut off or cleanout

In a designated accessible parking spot

Within 5 meters of a hydrant

Within 15 meters of an intersection; or within 30 meters of a signalized intersection

Do you intend to serve alcohol on the patio?

Undecided

Yes

Attach Photograph of Intended Site Location:

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