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P-44, r. 1 - Regulation respecting roadside advertising
Schedule
Disposition versions
SCHEDULE 1
(s. 1)
Gouvernement du Québec PERMIT
Ministère To be used only for erection
des Transports of a single advertising panel
(s. 1)
_________________________________________
|À l’usage du ministère des Transports |
| Année Région District N° séq. |
| |
|_________________________________________|
APPLICATION FOR PERMIT
1. Identification of the person responsible for the advertising panel
_________________________________________________________________________________
| Surname First name Telephone No |
| |
|_________________________________________________________________________________|
| Firm name (in the case of a legal person) |
| |
|_________________________________________________________________________________|
| Address of main establishment Postal code |
| |
|_________________________________________________________________________________|
| In the case of a legal person, indicate Telephone No |
| the name of a director |
|_________________________________________________________________________________|
2. Description of the advertising panel
_________________________________________________________________________________
| Dimensions of the panel Total height of advertising sign |
| (from top of panel to ground) |
| Height: m Width: m Height: m |
|_________________________________________________________________________________|
| For any structure placed 60 m or more from a highway, identify |
| the architect or engineer who made the plan |
| |
| Name Plan No Date |
|_________________________________________________________________________________|
3. Location
_________________________________________________________________________________
| Route Direction Distance from |
| edge of roadway |
| |
| metres |
|_________________________________________________________________________________|
| Cadastre No Municipality |
| |
|_________________________________________________________________________________|
| Name and address of landowner Telephone No |
| |
|_________________________________________________________________________________|
| À l’usage du Route Tronçon Section Chaînage Direction (sens) |
| ministère des |
| Transports -» |
|_________________________________________________________________________________|
4. Term of permit
_________________________________________________________________________________
| |
| ( ) 1 year ( ) 3 years ( ) 5 years Fees exigible: $ |
|_________________________________________________________________________________|
5. Preliminary authorizations
_________________________________________________________________________________
| Not required Required Included |
| |
| Municipality ( ) ( ) ( ) |
| |
| Commission de protection |
| du territoire agricole ( ) ( ) ( ) |
|_________________________________________________________________________________|
I certify that the information provided is complete and true and I am aware that a
false statement may result in my application being denied or my permit being
cancelled without compensation or refund of fees. I further recognize that the
signing of this form constitutes a permit application within the meaning of
section 1 of the Regulation respecting roadside advertising (chapter P-44, r. 1).
__________________________________________________________________________________
Name of signatory in block letters Signature Date
(In the case of a
legal person, the
signature of the person
authorized by resolution
to make the application)
_________________________________________________________________________________
| À l’usage du ministère des Transports |
| Chef de district |
| Je recommande la délivrance du permis _______________________________________ |
| Signature Date |
|_________________________________________________________________________________|
DÉLIVRANCE DU PERMIS autorisant l’installation du panneau publicitaire
(À l’usage du ministère des Transports)
N° du permis _______________
Le panneau publicitaire doit être installé
dans les 6 mois suivant la délivrance du
permis
Date d’échéance ____________
_______________________________________________________________
Directeur régional Date
Ministère To be used only for erection
des Transports of a single advertising panel
(s. 1)
_________________________________________
|À l’usage du ministère des Transports |
| Année Région District N° séq. |
| |
|_________________________________________|
APPLICATION FOR PERMIT
1. Identification of the person responsible for the advertising panel
_________________________________________________________________________________
| Surname First name Telephone No |
| |
|_________________________________________________________________________________|
| Firm name (in the case of a legal person) |
| |
|_________________________________________________________________________________|
| Address of main establishment Postal code |
| |
|_________________________________________________________________________________|
| In the case of a legal person, indicate Telephone No |
| the name of a director |
|_________________________________________________________________________________|
2. Description of the advertising panel
_________________________________________________________________________________
| Dimensions of the panel Total height of advertising sign |
| (from top of panel to ground) |
| Height: m Width: m Height: m |
|_________________________________________________________________________________|
| For any structure placed 60 m or more from a highway, identify |
| the architect or engineer who made the plan |
| |
| Name Plan No Date |
|_________________________________________________________________________________|
3. Location
_________________________________________________________________________________
| Route Direction Distance from |
| edge of roadway |
| |
| metres |
|_________________________________________________________________________________|
| Cadastre No Municipality |
| |
|_________________________________________________________________________________|
| Name and address of landowner Telephone No |
| |
|_________________________________________________________________________________|
| À l’usage du Route Tronçon Section Chaînage Direction (sens) |
| ministère des |
| Transports -» |
|_________________________________________________________________________________|
4. Term of permit
_________________________________________________________________________________
| |
| ( ) 1 year ( ) 3 years ( ) 5 years Fees exigible: $ |
|_________________________________________________________________________________|
5. Preliminary authorizations
_________________________________________________________________________________
| Not required Required Included |
| |
| Municipality ( ) ( ) ( ) |
| |
| Commission de protection |
| du territoire agricole ( ) ( ) ( ) |
|_________________________________________________________________________________|
I certify that the information provided is complete and true and I am aware that a
false statement may result in my application being denied or my permit being
cancelled without compensation or refund of fees. I further recognize that the
signing of this form constitutes a permit application within the meaning of
section 1 of the Regulation respecting roadside advertising (chapter P-44, r. 1).
__________________________________________________________________________________
Name of signatory in block letters Signature Date
(In the case of a
legal person, the
signature of the person
authorized by resolution
to make the application)
_________________________________________________________________________________
| À l’usage du ministère des Transports |
| Chef de district |
| Je recommande la délivrance du permis _______________________________________ |
| Signature Date |
|_________________________________________________________________________________|
DÉLIVRANCE DU PERMIS autorisant l’installation du panneau publicitaire
(À l’usage du ministère des Transports)
N° du permis _______________
Le panneau publicitaire doit être installé
dans les 6 mois suivant la délivrance du
permis
Date d’échéance ____________
_______________________________________________________________
Directeur régional Date
