Required fields are marked with asterisks (*)

Hearing Review - Request for Extension

A Person’s right to request an extension of time for a Hearing Review expires, if it has not been exercised, on or before forty-five (45) Days after the Screening Decision date, at which time: The Person shall be deemed to have waived the right to request a Review by Hearing Officer or request an extension of time for a Review by Hearing Officer; The Screening Decision is confirmed; and The Administrative Penalty shall not be subject to any further review, including a review by any Court, as per By-law 2023-048.

Required Documentation: Copy of the issued Administrative Monetary Penalty and a Copy of the notice of decision of the Screening Officer

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Reason(s) for extension to dispute the Administrative Monetary Penalty:

A. Property Information (Where Administrative Penalty Was Issued):

Building Number and Street Name

Unit Number

Location

Postal Code

Plan Number/Other Description

B. Owner Information

Name:

Corporation or Partnership:

Street Address

Unit Number

Location

Municipality

Postal Code

Province

Email Address

Telephone Number

C. Declaration of Owner

1. The information contained in this application and any other attached documentation is true to the best of my knowledge. 2. If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership.

Date:

Personal information contained in this form is collected under the authority of the Municipal Act, S.O. 2001, c.25, as amended and will be used to process the applicant’s Request for Review of the Screening Officer. Questions about this collection can be directed to the By-law Division, 1 Bailey Street, Port Carling, ON P0B 1J0, 705-765-3156 ext. 358, bylaw@muskokalakes.ca