"Application for a Permit to Construct and/or Modify a Water or Wastewater Treatment Facility" - Prince Edward Island, Canada

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Application for a Permit to Construct and/or
Modify a Water or Wastewater Treatment Facility
Pursuant to subsection 2(3) of the Water Act
Water Supply System and Wastewater Treatment System Regulations
Personal information on this form is collected under Subsection 6(4) of the Water Act and Section 31 of the Freedom of Information and Protection
of Privacy Act. Personal information collected will be used for the purposes of assessing your application for a permit that is necessary for the
construction or modification of drinking water and wastewater facilities. For information on the collection, use, or disclosure of this information,
contact the Drinking Water & Wastewater Management section, 11 Kent Street, PO Box 2000, Charlottetown, PE C1A 7N8 (902.368.5014).
Section 1 – Applicant
Name of official developer’s organization:
Name of contact person:
Mailing address:
Municipality:
Province:
Postal code:
Phone:
Email address:
Section 2 – Registered Property Owner(s) (if different from applicant)
Please note: If there is more than one property involved all PID’s and owner names are required. Please attach a separate sheet listing PID’s and Official
Landowners’ names.
Name of individual/organization:
Mailing address:
Municipality:
Province:
Postal code:
PID:
Phone:
Email address:
Utility name (if applicable):
Section 3 – Consulting Engineer
Name of engineering firm:
Name of design engineer:
Mailing address:
Municipality:
Province:
Postal code:
Phone:
Email address:
PEI Engineers License #:
Revised Feb 15, 2022
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P a g e o f 2
Application for a Permit to Construct and/or
Modify a Water or Wastewater Treatment Facility
Pursuant to subsection 2(3) of the Water Act
Water Supply System and Wastewater Treatment System Regulations
Personal information on this form is collected under Subsection 6(4) of the Water Act and Section 31 of the Freedom of Information and Protection
of Privacy Act. Personal information collected will be used for the purposes of assessing your application for a permit that is necessary for the
construction or modification of drinking water and wastewater facilities. For information on the collection, use, or disclosure of this information,
contact the Drinking Water & Wastewater Management section, 11 Kent Street, PO Box 2000, Charlottetown, PE C1A 7N8 (902.368.5014).
Section 1 – Applicant
Name of official developer’s organization:
Name of contact person:
Mailing address:
Municipality:
Province:
Postal code:
Phone:
Email address:
Section 2 – Registered Property Owner(s) (if different from applicant)
Please note: If there is more than one property involved all PID’s and owner names are required. Please attach a separate sheet listing PID’s and Official
Landowners’ names.
Name of individual/organization:
Mailing address:
Municipality:
Province:
Postal code:
PID:
Phone:
Email address:
Utility name (if applicable):
Section 3 – Consulting Engineer
Name of engineering firm:
Name of design engineer:
Mailing address:
Municipality:
Province:
Postal code:
Phone:
Email address:
PEI Engineers License #:
Revised Feb 15, 2022
1 |
P a g e o f 2
Section 4 – Additional Information (Attach to Application)
Check the box.
Section 8 – Additional Information (Attach to Application)
Stamped design drawings and specifications
Design summary/brief
Separate list of PID’s and owners (if applicable)
A separate itemized cost estimate including construction, contingency, engineering, and HST for each component of the following;
wastewater collection;
wastewater treatment;
water treatment;
water distribution; and
total cost of above.
Specify the desired period for carrying out the proposed activity.
Start date (dd/mm/yyyy):
End Date (dd/mm/yyyy):
Section 5 – Fees & Declaration
There is a fee to obtain a Permit to Construct or Modify a facility, as follows:
Total Project Cost less than $200,000 - fee of $100
Total Project Cost less than $200,000 to $999,999 - fee of $500
Total Project Cost more than $1,000,000, - fee of $1,000
Fees are HST exempt.
Arrangements for fee payment can be made by calling 902.368.5014. Please ensure to reference engineering firm, design engineer
on record, project title, and project cost.
By signing this form, you acknowledge the information supplied is accurate and true.
Applicant Signature:
Date (dd/mm/yyyy):
Property Owner Signature:
Date (dd/mm/yyyy):
Section 6 – Department Contact
Morley Foy, P.Eng. – Approvals & Compliance Engineer
Telephone:
..........................................
902.368.5036
Fax:
.....................................................
902.368.5830
Email:
..................................................
mmfoy@gov.pe.ca
Revised Feb 15, 2022
2 |
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