Application Free Snow Removal from City Sidewalk

If you require information about this program, please contact the following Office: Ward Toronto and East York District, Tel: 416-392-7768

Applicant's First Name Applicant's Last Name

Applicant's First Name Applicant's Last Name

Address Postal Code

Telephone No. Do you have a corner property If yes, corner Street Name

Yes No

ELIGIBILITY REQUIREMENTS (Please check box(es) appropriate for you):

Resident owner of one or two family dwelling Occupant of a one or two family dwelling Over age 65 (proof of age required) Under age 65 and have a physical disability. I am unable to remove snow from the sidewalk without endangering my health. Proof of disability (i.e. accessible parking permit or doctor’s note) is attached. No relatives under age 65 reside at this address Relatives under age 65 residing at this address have a physical disability. His/her/their health would be endangered by removing snow from the sidewalk.

We are relatives of the applicant residing at the same address. We are under age 65 with a physical disability. Proof of disability (i.e. accessible parking permit or doctor’s note) is attached.

Signature: ______Date (yyyy-mm-dd):______

Signature: ______Date (yyyy-mm-dd):______

Mail your signed application form with any necessary documentation to:

Transportation Services, Toronto and East York District Right of Way Management East York Civic Centre 850 Coxwell Avenue Toronto, Ontario M4C 5R1 Please Note: Photocopy of proof of disability or age is acceptable. Processing time from receipt of your application is 7 to 10 working days. I am aware that this service does not include the clearing of snow from driveways or private approaches to residences, and I agree to notify the City in the event that I no longer qualify for this service. Date (yyyy-mm-dd) Signature

The personal information on this form is collected under the authority of the City of Toronto Act, S.O. 2006, Chapter 11, Schedule A, s. 136 (c) and Toronto Municipal Code, Chapter 719. The information will be used to process your application for free snow removal from City sidewalk. Questions about this collection can be directed to the Senior Communications Co-ordinator, Toronto City Hall, 100 Queen Street West, East Tower 23rd Floor, Toronto, Ontario, M5H 2N2 or by phone at 416-392-4391.

FOR OFFICE USE ONLY

Frontage District/Office

Flank Application Received By

Rear Entered By

13-0012 2015-10