Required fields are marked with asterisks (*)

Hauled Sewage Application Form

Company Name

Primary Contact Name

Street Address

City

Postal Code

Phone Number

Email Address

Ministry of Environment, Conservation and Parks Environmental Compliance Approval (ECA) or Environmental Activity and Sector Registry (ESAR) #

Vehicle Information for all vehicles that will be disposing hauled sewage at LPCC:

Truck Number or Identifier

License Plate

Tank Capacity (IG/m3)

Add Remove

Required Documents

MECP approval

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

Please upload a Current WSIB Certificate

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

Certificate of Insurance (General Commercial Liability and Automobile Liability)

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

Hauler acknowledges that it has reviewed and agrees to comply with the requirements and fees outlined in the Municipality of Leamington Hauled Sewage Policy ES-2026-01

I certify that all information provided above is true, accurate and complete to the best of my knowledge. I will notify the Municipality of Leamington of any changes immediately.

Applicant Signature

Clear

Application Date

Privacy Statement: Personal information on this form is collected under the authority of the Municipal Act, 2001 P.S.O. c.45, and will be used to administer its Hauled Sewage application form. Questions about the collection of this information can be directed to the Manager of Legislative Services/Clerk, Municipality of Leamington, 111 Erie Street North, Leamington, N8H 2Z9, Telephone: 519-326-5761.

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