SCHEDULE AD@
APPLICATION FOR COUNCIL EXEMPTION
Name(s) of Owner: ___________________________________________________
Address: _____________________________ Postal Code:
_____________
Telephone: Residence: ______________ Business: ____________ Fax: ___________
E-Mail: ______________________________________________________________
Location of Trees Affected / Ownership
Municipality ______________________ Assessment Roll Number______________
Lot_______ Concession_________ 911 Address_________________________
Property owned by applicant? _____ YES
______ NO (if No, authorizing letter must be attached)
If purchased within the last three years, state name and address of former owner and the date you
purchased it. __________________________________________________________________
Property / Forest Description ___________________________________________________________
This application is requesting a Permit to remove the following (please indicate)
Total Area: ________________Hectares ______________ Acres ________________
Total Woodland Hectares (Acres) on the Property: _______Hectares _______ Acres
Tree species to be destroyed
on the described land: ___________________________
This Exemption is requested for the following reasons, including description of end use after trees have
been destroyed: ___________________________________________________________________
Is the applicant willing to offset the destruction of trees on the subject property through replanting trees
on said property? Yes ______ No ______
Please return this application with a cheque made payable to the Corporation of the County of
Middlesex in the amount of $100.00 to the County Clerk=s Office, 399 Ridout Street North,
London, Ontario. N6A 2P1
Personal information on this form is collected under the authority of the Municipal Act. Pursuant to the
Municipal Freedom of Information and Protection of Privacy Act, questions about the collection of
personal information should be directed to the Clerk.
Council Exemption Requirements / Information
I. A Council Exemption application must be completed in full in order to be processed. An
application for an area greater than 1 (one) hectare (2.5 ac.) must be accompanied by an
Environmental Impact Study.
II. It shall be normal practice that when an owner or his authorized agent makes an inquiry with
regard to Woodlands Conservation By-law No. 5738 that the Officer will make an inspection of
the property to determine whether or not an application for a Council Exemption is necessary.
Notice of this permit application shall be sent by regular mail to all landowners whose lands abut
the land the applicant has outlined. Landowners separated by a public road allowance shall also
be considered to be abutting landowners. Further circulation of this application may be made to
the appropriate government agencies for review and comments (i.e. Conservation Authorities,
Ministry of Natural Resources, Ministry of Agriculture Food and Rural Affairs, and local
Municipalities).
III. Any person who has made an application for a Council Exemption Permit shall erect and display
a public notice regarding the Council Exemption application at the entrance from the adjoining
roadway to the land where the Council Exemption Permit is being sought in a position that is
clear and visible to all persons, and such sign shall be in the format of Schedule AD@.
IV. The hearing for the application shall not be held less than twenty-one (21) working days from
receipt of the application.
V. If the application is approved an on site inspection will be made and the perimeter of the forest
cover which will remain will be marked with paint or some other means, to clearly indicate the
extent of the approved Council Exemption Permit area. Trees destroyed outside any approved
area will be considered a violation under the Woodland Conservation By-law No.___.