HomeMy Public PortalAbout2020-06-03_Form_Application_COVID-19 LUB Temporary Relief.pdfPage 1 of 2
Temporary COVID-19
Land Use Compliance Relief Application
Corporate & Strategic Management Department
PO Box 369, 151 Central Street
Chester, NS B0J 1J0
Phone: 902-275-4147
E-mail: hhennigar@chester.ca
CIVIC ADDRESS OF THE PROPERTY/BUSINESS:
Civic Street Name Community
TYPE OF BUSINESS:
□ Café, Restaurant, Pub, Diner or Similar
□ Retail
□ Personal Service, Salon, Hairdresser, or Similar
□ Other:
CONTACT INFORMATION:
Business Name
Applicant Name
Phone
Email
Mailing Address
Postal Code
SUPPORTING DOCUMENTS: Submitted
Date of Temporary Expansion □
End Date of Temporary Expansion □
Hours of Operation of Business □
Hours of Operation of Expansion Area □
Proof of Liability Insurance, $1,000,000 minimum, with the Municipality named as a covered party. □
NS Dept. of Transportation Approval, if expanding onto sidewalk and or road right of way, including
parking spaces. □
Municipal Public Works Approval if expanding onto sidewalks □
If expanding into street parking spaces, include the number of parking spaces you wish to expand into. □
Site Sketch or Plot Plan showing:
• Property Boundaries
• Existing Structures with used noted
• Location of proposed temporary expansion area
• Distance to the property lines for temporary expansion area
• Dimensions of temporary expansion area
Use of temporary expansion area (ie: extra seating, tables for retail space, etc)
□
If temporary expansion area will impede pedestrian space, include proposed safe alternate route for
pedestrians, including dimensions of any walkways □
Construction plans for any boardwalks, decks, etc □
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* TERMS & CONDITIONS
1. The Owner of the Business agrees to remove any temporary relief area and use by the end date stipulated by
the Municipality even if it is different than the requested date on the application.
2. This compliance relief does not exempt any person, owner, or business from complying with the Land Use By-
Law after the end date stipulated by the Municipality for any temporary relief area nor does it relieve
compliance from any other LUB requirement not specified herein.
3. The owner of the business acknowledges the temporary relief area is operating out of compliance with the
Land Use by-law and is requesting that the Municipality not enforce compliance for the area until after the
end date as agreed to by the Municipality.
* BUSINESS OWNER CERTIFICATION (Please check which is applicable)
As the business owner I hereby affirm the expansion of the existing use into the temporary expansion area will maintain
compliance with all Nova Scotia Public Health guidelines and requirements and:
□ As the business owner I hereby certify that I am either the owner of the land on which this temporary expansion area
is proposed, OR
□ I am making this application with the consent of the property owner.
Date:
YYYY - MM - DD
Print Name:
Signature: