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FORM A5: SIGN APPLICATION
Supplement to Development Permit Application
Land Use Bylaw 2016-21
County of Newell Land Use Bylaw 2016-21 Page 1 of 2
• This form is to be completed in conjunction with Form A1: Development Permit Application.
A PPLICANT INFORMATION
(1) Applicant Name: ___________________________________________
(2) Sign dimensions:
Length: _________ Width: __________ Area of proposed sign: _______________
Height from Ground to Bottom of Sign: _____________
Height from Ground to Top of Sign: _____________
Show the location(s) of the proposed sign(s) on the Site Plan for Form A1.
(3) Will the sign be illuminated No Yes
Flashing and Running signs are NOT ALLOWED
(4) Are there any existing signs on the lot? No Yes
If yes, describe the type, size and height of each existing sign and identify their location(s) on the site plan for
Form A1.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
(5) Please list any other information that you think the County needs to know regarding the approval of this sign
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
OFFICE USE
Permit Number:
(From Form A1)
Roll Number:
Type of Sign:
Freestanding Canopy/awning Wall mounted/painted Fascia Portable
Roof mounted Projecting Billboard Other ___________________
FORM A5: SIGN APPLICATION
Supplement to Development Permit Application
Land Use Bylaw 2016-21
County of Newell Land Use Bylaw 2016-21 Page 2 of 2
DECLARATION OF APPLICANT/LAND OWNER
The information given on this form is full and complete and is, to the best of my knowledge, a true statement of the
facts in relation to the application for a sign. I consent to an authorized person designated by the municipality to enter
upon the subject land and buildings for the purpose of an inspection during the processing of this application.
IMPORTANT: This information may also be shared with appropriate government/other agencies and may also be kept
on file by those agencies. The application and related file contents will become available to the public and are subject
to the provisions of the Freedom of Information and Protection of Privacy Act (FOIP).
Date: _______________________ Applicant Signature: ___________________________________
Registered Owner: ___________________________ ________________________
(Required, if different from applicant) Print Name Signature
Or
Written approval has been submitted by the registered owner stating that the applicant is authorized to
sign this application form.
Date written approval was submitted: _________________