Township of Southgate Civic Address Request Form

Civic Address Number Request
By-law 2011-011
Municipal Civic Addressing

Property Information

Former Township Of

Roll Number

Is this a severance from the above parcel with no roll number at this time?

Yes

No

Owner Name

Mailing Address

Phone Number

E-Mail Address

Legal Description: Lot

Concession

Plan and Part Number

Existing Civic Address

No Existing Civic Address #

No Existing Civic Address

Existing Land Line Phone Number

Is this a change in address?

Yes

No

Is this an additional address? (Ex. Business, Barn, etc)

Yes

No

Sketch:
Please provide a clean sketch displaying the subject property, location of entrance and the road name.
Provide distance in metres from the centre line of the entrance to the nearest property line.

Sketch Upload

Browse…

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

Distance:

Metres To Respective Property Line

North

South

East

West

Fee:

Fee of $148.00 Payable to Township of Southgate (Fees and Charges effective February 5, 2025, By-law 2025-014)

Received

Yes

No

Date

Initial

Entered by Municipal Staff Only

Forms

Township of Southgate Civic Address Request Form

Civic Address Number RequestBy-law 2011-011Municipal Civic Addressing

Civic Address Number Request
By-law 2011-011
Municipal Civic Addressing