Required fields are marked with asterisks (*)

Noise Exemption Request Form

Circulation:

Confirm that the required form has been shared with all homes within 120 metres of the event location.

Additional Conditions

Make sure to submit all required information at least 45 days before your event.

Keep in mind that if the conditions aren’t followed, the exemption could be revoked

This form does not replace the requirement to notify the Belleville Police Service if applicable.

Name of Applicant

Address

City/Town

Postal Code

Phone Number

Email Address

Name of person responsible for supervising the event

Declaration from applicant that the person named as the supervisor of the event will be on site for the duration of the exemption period.

Yes

Details of Noise Exemption

Type of Noise (e.g., Music, Construction equipment):

Explain why this exemption is being requested and why the project can’t meet the requirements of the Noise By-law:

How long are you requesting the exemption for (Start)

How long are you requesting the exemption for (End)

Noise Exemption Request Fee

$250

Noise Exemption Request Total

Applicant Signature

Clear

Date