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Source Water Protection: Restricted Land Use Declaration
Clean Water Act - S.59 Screening Form

The information on this form will help the City of Brantford determine if a development or building application is subject to any Part IV policies under the City’s Source Protection Plan. Any application requiring a Risk Management Plan will be negotiated with the Risk Management Official. The Risk Management Official will determine the appropriate stage of the process for the negotiation.

Please complete the form as accurately and thoroughly as possible. Additional information may be requested to complete the Source Water Protection evaluation. Please be advised that personal contact information is required to complete this form.

These questions are only regarding the future proposed development, not for any existing operation. 

The purpose of this Source Water Protection questionnaire is to screen for any new drinking water threats that could be introduced with an application.

If you require assistance with any questions or need additional information, please contact SourceProtection@brantford.ca or 519-759-4150 Ext. 5829.

Property & Contact Information

Type of Application
 

Personal information, as defined in the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), is collected and authorized under Section 10(1) of the Municipal Act, 2001, and will be used to process your Source Water Protection Restricted Land Use request.

For further information, call the Risk Management Inspector at (519) 759-4150 Ext. 5829 or email at sourceprotection@brantford.ca