OFFICIAL COMMUNITY PLAN AMENDMENT APPLICATION PROCESS Planning Department-Development Services Division 171 Main St. Penticton B.C. V2A 5A9 P: (250) 490-2501 E: development@penticton.ca OFFICIAL COMMUNITY PLANS IN GENERAL: An Official Community Plan is a document, passed by a local government, that sets out, among other things, the future land uses of property within a city s jurisdiction. The ability to designate lands is granted to local governments by the Province through the Local Government Act. An OCP may designate land uses and densities. Amendments to the Official Community Plan need to be approved by Council after a public hearing. PRIOR TO APPLICATION: It is the applicant s responsibility to know what permits are required for their development and make all applicable applications. It is also the responsibility of the applicant to know of any special conditions may exist on the subject property. For applications with identified hazards or environmental considerations, additional information is usually required. City staff are available to provide basic background information on any properties in the city. More detailed information, such as geotechnical data or wildfire hazard analysis is the requirement of the applicant and their consulting professionals. Staff suggest that prospective applicants schedule a pre-application meeting to discuss their application prior to detailed 1 2 SUBMIT APPLICATION Only complete applications will be accepted. Once the application is deemed complete and the application fee has been submitted, the application will be assigned to a Planner for review. REFERRAL PERIOD All OCP amendment applications are referred to the Technical Planning Committee and other external agencies as required. The TPC members and outside agencies are given the opportunity to comment on the application to identify any issues that may come up as part of the development process. 3 COMPREHENSIVE REVIEW AND APPLICANT CONSULTATION Once the file manager has received comments from the Technical Planning Committee and any external agencies, a more comprehensive review of the project is undertaken. The file manager will correspond with the applicant to address any outstanding issues required to be dealt with to bring the application up to a level that staff can support. The applicant may be required to upgrade drawings and re-work the application to START WEEKS 1-2 WEEKS 1-4 4 5 DECISION PROCESS Once an application is at a point where the file manager will make a recommendation for Council to support the application, or support the application with conditions, the file manager will submit a report for Council s consideration and a Bylaw is created and given first reading. PUBLIC NOTIFICATION Once a Bylaw is given first reading, all owners and residents of property within a 30m radius of the subject property are required to be notified of the application and provided with the opportunity to express support or otherwise at a Public Hearing. A sign is to be posted on the property and notification in the newspaper is also required. 6 COUNCIL CONSIDERATION After the Public Hearing, Council will decide on whether to deny the application or give the Bylaw a third reading with conditions, or third reading and adoption. If conditions are given, the applicant must complete all of the conditions outlined in Council s resolution. Once the conditions are complete, the application will be scheduled at the earliest available Council WEEKS 4-8 WEEKS 4-8 WEEKS 6-8 PLEASE NOTE: Processing times vary depending on the complexity of the project and the volume of applications being considered by the Department. Partial refunds on applications are given if an application is retracted prior to Council consideration.
Development Application Planning Department-Development Services Division 171 Main St. Penticton B.C. V2A 5A9 P: (250) 490-2501 E: development@penticton.ca Application(s)# Master Project # Type of Application (check all that apply) Rezoning (Public Notice Sign(s) Required) OCP Amendment (Public Notice Sign(s) Required) Development Permit Subdivision (Fee Simple & Bareland Strata) Development Variance Permit Strata Conversion Temporary Use Permit Phased Strata ALR Other Fee Total (See Fee Schedule) $ Applicant Information (Property Owner or Agent**) Name(s): Phone: Revised: March 1, 2016 **See Agency Agreement Company: Address: Cell: Email: Property Owner Information Name(s): Company: Address: Phone: Cell: Email: Property Information Civic Address(es): PID & Legal Description: Current Zoning Designation: Current Official Community Plan Designation: Description of Proposed Development/Application For Office Use Cheque No: Name/Address: Date Received: Amount: Received By:
Coordinating Professionals: List any professionals known to date (such as an architect, surveyor, engineer, etc). Use additional sheet if necessary. Name: Phone: Company: Address: Cell: Email: Name: Company: Address: Phone: Cell: Email: Application Checklist: The following list outlines all of the information necessary to provide a timely decision on your application. All items on the list must be provided with the application. We are unable to accept applications that do not have all of the required items Applicant to Complete Staff to Complete Required Items Completed application form Current title search: Searched within 30 days. Include current copies of any restrictive covenants, easements or utility rights-of way Site Profile / Site Profile Waiver / Certificate of Compliance from MOE $100 MOE referral fee is required if Schedule II uses are identified. Plans: a) Paper Copy: 1 copy to be submitted with application b) Digital Plans: Email planning@penticton.ca. Include the civic address and Type of Application in the subject line. c) Landscape Plans: Required for Development Permit applications. Plan to be prepared by a landscape professional and include a species list. All plans must be in metric, be clearly legible, show all property lines and dimensions and include a scale and Zoning Bylaw Compliance Table. Agency Agreement: If the owner is not the applicant. Letter of Intent: Outline the project and reason for the application. Include information that you would like staff and Council to consider when reviewing your proposal. Application Fee Initial Initial Applicant/Agent Confirmation As applicant, I confirm that I have attached to this application the required plans and specifications of the proposed development in accordance with the application checklist. I accept responsibility for processing delays caused by incorrect or insufficient submission materials. I understand that this application form is a public document and that any and all information contained in it, including personal information as that term is defined in the Freedom of Information and Protection of Privacy Act of BC, is open for inspection by the public and may be reproduced and distributed to the public as part of a report(s) to Council or for purposes of a public hearing. And, I understand that approval is subject to Staff and Council deliberation and assessment Print Name Signature Date
Development Application-Fee Schedule Planning Department-Development Services Division 171 Main St. Penticton B.C. V2A 5A9 P: (250) 490-2501 E: development@penticton.ca Effective March 1, 2016 OCP Amendments Fee Stand alone OCP Amendments in Country Residential, Low Density Residential and Agricultural designated areas $1,575.00 All other stand alone OCP Amendments $1,890.00 OCP Amendments in Country Residential, Low Density Residential and Agricultural designated areas (where in conjunction with a Rezoning Application) $1,057.00 All other stand alone OCP Amendments (where in conjunction with a Rezoning Application) $1,282.50 OCP Text Amendments $1,507.50 Rezoning Stand alone Rezoning applications in Country Residential, Low Density Residential and Agricultural designated areas. $1,215.00 All other stand alone Rezoning applications. $1,665.00 Zoning Bylaw Text Amendments $1,125.00 Comprehensive Development Zone $2,250.00 Public Notice Signs (OCP Amendments/Rezoning) Initial OCP or Zoning Bylaw Sign $262.50 (incl. GST) Repair of Damaged Signs $84.00 (incl. GST) Replacement of damaged signs $84.00 (incl. GST) Additional Public Hearing Fee $550.00 Development Permit Application Major Development Permit (Council Decision) $1,125.50 Minor Development Permit (Staff issuable) $675.00 Major Amendments to Development Permits (Council Decision) $562.50 Minor Amendments to Development Permits (Staff issuable) $337.50 Appeal to Council of a Staff Decision on a Development Permit $675.00 Reissuance of an expired Development Permit $450.00 Riparian / Environmental Assessment Development Permit $225.00 Development Variance Permit Application or Board of Variance Application Major Variance (3+ Variances per development) $1,125.00 Major Variance (3+ Variances per development) if in conjunction with a Development Permit Application $675.00 Minor Variance (1 or 2 Variances per development) $600.00 Minor Variance (1 or 2 Variances per development) if in conjunction with a Development Permit Application $450.00 Reissuance of expired Development Variance Permit $450.00 No additional fee is required for a Variance where it is issued under Section 920 (2) of the LGA
Temporary Use Permit Fee Temporary Use Permit $800.00 Temporary Use Permit Renewal $400.00 Subdivision (Fee Simple & Bareland Strata) Preliminary Layout Approval Review 1-2 Lots $330.00 3-10 Lots 11-20 Lots $330.00 +$300.00 per lot in excess of 2 lots $2,885.00 + $220.00 per lot in excess of 10 lots 21-30 Lots $5,085.00 + $190.00 per lot in excess of 20 lots 31-40 Lots 41 Lots or Greater $7,010.00 + $165.00 per lot in excess of 31 lots $8,660.00 + $110.00 per lot in excess of 40 lots Preliminary Layout Approval, Renewal or Amendment $150.00 Legal Plan Approval Fee $63.00 (incl. GST) Early Registration Agreement (Applicable to Fee Simple Subdivisions) $750.00 Strata Conversion First Lot $300.00 Each Additional Lot $150 per conversion to a max. of $2,000.00 Report Inspection Fees i) Third Party Review of Professional Reports submitted with an Application Actual Cost Legal Plan Approval Fee $63.00 (incl. GST) Phased Strata Phasing Approval Fee $450.00 Legal Plan Approval Fee $63.00 (incl. GST) From P Approval $105.00 (incl GST) Preliminary Layout Approval, Renewal or Amendment $150.00 ALR ALR Exclusion/Inclusion/Subdivision/Non Farm Use $600.00 Other Administrative Fees Ministry of Environment-Site Profile Referral $100.00 Land Title Search (when not provided at time of application) $21.00 (incl. GST)
Agency Agreement Planning & Building Department Development Services 171 Main St. Penticton B.C. V2A 5A9 P: (250) 490-2501 F: (250) 490-2502 24 Hour Inspection Line: (250) 490-2511 SUBJECT PROPERTY(IES) PID(s) & LEGAL DESCRIPTION(S) AGENT S NAME (& COMPANY NAME) MAILING ADDRESS I/We, the Registered Owner(s) of the property identified above, hereby appoint the person(s), identified above, as my/our agent with authority to endorse on my/our behalf, applications, documents and/or permits, other than documents to be registered in the Land Title Office, pertaining to the construction of a building, structure, or other improvement in, on, over or under the aforementioned property (the project ) and to represent me/us in all discussions with the City of Penticton and its employees regarding the construction of the building, structure or improvement. Any correspondence in relation to the project may be sent to the Agent s address indicated above. Yes No If no, please use this address for all correspondence: The above agent(s) shall be authorized to act on my behalf on the applications below and/or to access the information below (initial all that apply): APPLICATION INITIAL APPLICATION INITIAL OCP Amendment Application Subdivision Permit Application Rezoning Application Strata Conversion Application Development Permit Application Strata Subdivision Application Development Variance Application Building Permit Application** Board of Variance Application Plumbing Permit Application** Access to property files Demolition Permit Application** ALR Application Sign Permit Application** Temporary Use Permit Application Specific to Building Permit Applications** I/We accept and understand that during any construction I/we have the overall responsibility for assuring the building conforms to the requirements of the Building Code. The process of assessing conformity to the requirements during construction is the responsibility of the registered professionals for complex (Part 3 BC Building Code) buildings, and the designer/builder for standard (Part 9 BC Building Code) buildings. I/we further understand that this authorization will remain in full force and effect until the permit expires, which is two (2) years after the permit has been issued OR until I/we notify the City of Penticton in writing that it has been revoked. Person(s) wishing to extend the Agency agreement must have the request in writing to the Development Services Director. Signature(s) of Registered Owner(s) or Signing Officer(s): Please Print Name Signature Date
Public Notice Sign Requirements Planning Department-Development Services Division 171 Main St. Penticton B.C. V2A 5A9 P: (250) 490-2501 E: development@penticton.ca Revised: March 1, 2016 Public notice signs are required for Rezoning and Official Community Plan amendment applications. The City of Penticton will make the necessary arrangements with our contracted sign company on your behalf. Please complete the attached form and submit it with your application. Fee & Location: A fee of $262.50 ($250.00 plus applicable taxes) per public notice sign is paid to the City of Penticton at the time the Rezone and/or OCP Amendment Application is made. The number of signs required is determined prior to the application being submitted to City Hall. A public notice sign shall be located on each street frontage of the site in order to inform the public about the nature and purpose of the Rezone and/or OCP Amendment Application. Small corner sites may be permitted to have only one sign. If you have any questions/concerns about the number of public notice signs required for your application, please phone Heather McDonald, Planning Clerk at (250) 490-2523 or email heather.mcdonald@penticton.ca. Timing & Posting: It is the applicant s responsibility to ensure the public notice sign is in place for the required period of time and that it is not vandalized or stolen. After Council has given first reading to the Zoning Bylaw and/or OCP Amendment, the sign(s) shall be erected on site not less than ten (10) days prior to the Public Hearing. This means, that if your application has been given first reading at a regular Monday evening Council meeting the sign will be erected on the site by 12 Noon Thursday following Council. The sign shall be removed by the sign company three (3) days following the Public Hearing. Fee to Repair the Sign: The fee, payable to The City of Penticton to repair the sign is $84.00 ($80.00 plus applicable taxes). This fee must be paid immediately so as to not delay the Public Hearing process. Fee to Replace the Sign: The fee, payable to The City of Penticton to replace the sign is $84.00 ($80.00 plus applicable taxes). This fee must be paid immediately so as to not delay the Public Hearing process. If you have any questions about the public notice sign process, or if you need to report a damaged or stolen sign, please contact Heather McDonald, Planning Clerk at (250) 490-2523 or heather.mcdonald@penticton.ca.
Public Notice Sign Information Planning Department-Development Services Division 171 Main St. Penticton B.C. V2A 5A9 P: (250) 490-2501 E: development@penticton.ca Public Notice Sign Information Sheet Please submit this form with your Rezone and/or OCP Amendment Application Number of Signs Required: Subject Property(ies) Contact Information (Information to be printed on the sign) Name: Address (include street, City/Prov and postal code): Phone #:
Site Profile Waiver Planning Department-Development Services Division 171 Main St. Penticton B.C. V2A 5A9 P: (250) 490-2501 E: development@penticton.ca The City of Penticton requires applicants who are not submitting a site profile under the Environmental Management Ac to submit a Site Profile Waiver Please review the Ministry of Environment Site Profile requirements to determine if you must submit a site profile. If you are not required to submit a site profile under the Environmental Management Act, please fill out the form below, acknowledging that you are electing not to submit a site profile at this time. REASON FOR SUBMISSION Subdivision Rezone Development Permit Development Variance Permit Demolition Permit Soil Removal ADDRESS OF SUBJECT PROPERTY(IES) PID(s) & LEGAL DESCRIPTION(S) I,, hereby acknowledge that the Environmental Management Act is effective as of October 25, 2004. Based on my personal knowledge of the property, and such investigations as I deemed necessary, there has been no prior use of the said property for any industrial or commercial activity and more particularly, the industrial or commercial activities referred to in Schedule 2 of the Environmental Management Act. Accordingly, I elect not to complete and submit a site profile, as outlined in Section 40 of the Act. I further acknowledge that this election does not remove any liability, which may otherwise be applicable under the legislation. Applicant/Agent Signature Print Name Date Signed: Internal Use Received By: Date Received:
http://www.env.gov.bc.ca/epd/remediation/site_profiles/index.htm Page 1 of 2 8/7/2013 Ministry of Environment Site Profiles Site profiles are a screening tool used to identify potentially contaminated sites. They are completed and submitted when potentially contaminated sites are being decommissioned, are in foreclosure proceedings, are subject to local government applications and/or permits, and are being sold. The Site Profile Form is provided in Schedule 1 of the Contaminated Sites Regulation. Schedule 2 lists the industrial and commercial activities triggering site profile submission to the ministry. More detailed guidance is provided in the following links. Site Profiles e-link Mailing List NEW JANUARY 2009 Join the SP e-link mailing list Recent SP e-link messages Fact Sheets 19 The Site Profile System (PDF/117 KB) UPDATED july 2013 5 Site Profiles: Local Governments Duties (PDF/191 KB) UPDATED july 2013 6 Site Profile Administration - Local Government Opt Out Option (PDF/164 KB)UPDATED AUGUST 2008 35 Requirements for the Environmental Cleanup of Illegal Drug Manufacturing Sites (PDF/176 KB) UPDATED january 2009 37 Site Profile Freeze and Release Provisions (PDF/148 KB) ISSUED june 2007 42 Subscribing to our Site Profiles E-mail Service (PDF/156 KB) new january 2009 43 Site Profile Requirements for Site Decommissioning (PDF/139 KB) new july 2009 44 Site Profiles and Foreclosure (PDF/98 KB) new july 2009 Administrative Guidance 1 Completing and Submitting Site Profiles (PDF/196 KB) UPDATED AUGUST 2013 2 Site Profile Processing Requirements for Municipalities and Approving Officer (PDF/150 KB) UPDATED july 2013 6 Site Profile Decisions and Requesting Releases Where Local Government Approvals are Required (PDF/290 KB) UPDATED AUGUST 2013 Q&As Site Profiles
http://www.env.gov.bc.ca/epd/remediation/site_profiles/index.htm Page 2 of 2 8/7/2013 Forms Site Profile Form with Instructions (PDF/46 KB) Form Letters Requesting a No Site Investigation Decision (MS DOC/40KB) Requesting a Release Notice (MS DOCX/25KB) UPDATED AUGUST 2013 Laws and Regulations Environmental Management Act / Section 40 July 6, 2009 Update (PDF/90 KB) NEW JULY 2009 Contaminated Sites Regulation Part 2 Schedule 1 Site Profile Form Schedule 2 Industrial and Commercial Purposes and Activities Triggering Site Profile Submissions For more information, contact the ministry at siteprofiles@gov.bc.ca. This Page Was Last Modified on: August 1, 2013
Introduction SCHEDULE 1 Site Profile Version 4.0 Under section 40 of the Environmental Management Act, a person who knows or reasonably should know that a site has been used or is used for industrial or commercial purposes or activities must in certain circumstances provide a site profile. Schedule 2 of the Contaminated Sites Regulation sets out the types of industrial or commercial purposes or activities to which site profile requirements apply. If section 40 of the Environmental Management Act applies to you and you know or reasonably should know that the site has been used or is used for one of the purposes or activities found in Schedule 2 of the Contaminated Sites Regulation, you may be required to complete the attached site profile. Notes/Instructions: Persons preparing a site profile must complete Section I, II and III, answer all questions in sections IV through IX, and sign section XI. If the site profile is not satisfactorily completed, it will not be processed under the Environmental Management Act and the Contaminated Sites Regulation. Failure to complete the site profile satisfactorily may result in delays in approval of relevant applications and in the postponement of decisions respecting the property. The person completing this site profile is responsible for the accuracy of the answers. Questions must be answered to the best of your knowledge. Section 27 (1) of the Freedom of Information and Protection of Privacy Act requires that provision of personal information concerning an individual must be authorized by that individual. Persons completing the site profile on behalf of the site owner must be authorized by the site owner. One (1) site profile may be completed for a site comprised of more than one titled or untitled parcel, but individual parcels must be identified. The latitude and longitude (accurate to 0.5 of a second using North American Datum established in 1983) of the centre of the site must be provided. Also, please attach an accurate map, containing latitude, longitude and datum references, which shows the boundaries of the site in question. Please use the largest scale map available. If the property is legally surveyed, titled and registered, then all PID numbers (Parcel IDentifiers Land Title Registry system) must be provided for each parcel as well as the appropriate legal description. If the property is untitled Crown land (no PID number), then the appropriate PIN numbers (Parcel Identification Numbers Crown Land registry system) for each parcel with the appropriate land description should be supplied. If available, the Crown Land File Number for the site should also be supplied. Anything submitted in relation to this site profile will become part of the public record and may be made available to the public through the Site Registry as established under the Environmental Management Act. Under section 43 of the Environmental Management Act, corporate and personal information contained in the site profile may be made available to the public through the Site Registry. If you have questions concerning the collection of this information, contact the Site Registrar, at site@gov.bc.ca. For questions on site profiles, please send a message to siteprofiles@gov.bc.ca. 1
I CONTACT IDENTIFICATION A. Name of Site Owner: Last First Middle Initial(s) (and/or, if applicable) Company Owner s Civic Address City Province/State Country Postal Code/ZIP B. Person Completing Site Profile (Leave blank if same as above): Last First Middle Initial(s) (and/or, if applicable) Company C. Person to Contact Regarding the Site Profile: Last First Middle Initial(s) (and/or, if applicable) Company Mailing Address City Country Telephone ( ) - Province/State Postal Code/ZIP Fax ( ) - II SITE IDENTIFICATION Please attach a site location map All Property Coordinates (using the North American Datum 1983 convention) for the centre of the site: Latitude: Degrees Minutes Seconds Longitude: Degrees Minutes Seconds Please attach a map of appropriate scale showing the boundaries of the site. For Legally Titled, Registered Property Site Street Address (if applicable) City Postal Code 2
PID numbers and associated legal descriptions. Attach an additional sheet if necessary. PID Legal Description Total number of titled parcels represented by this site profile is: For Untitled Crown Land PIN numbers and associated Land Description. Attach an additional sheet if necessary. PIN Land Description Total number of untitled crown land parcels represented by this site profile is: (and, if available) Crown land file numbers. Attach an additional sheet if necessary. III COMMERCIAL AND INDUSTRIAL PURPOSES OR ACTIVITIES Please indicate below, in the format of the example provided, which of the industrial and commercial purposes and activities from Schedule 2 have occurred or are occurring on this site. EXAMPLE Schedule 2 Description Reference E1 appliance, equipment or engine repair, reconditioning, cleaning or salvage F10 solvent manufacturing or wholesale bulk storage Please print legibly. Attach an additional sheet if necessary Schedule 2 Description Reference 3
IV AREAS OF POTENTIAL CONCERN Is there currently or to the best of your knowledge has there previously been on the site any (please mark the appropriate column opposite the question): YES NO A. Petroleum, solvent or other polluting substance spills to the environment greater than 100 litres? B. Residue left after removal of piled materials such as chemicals, coal, ore, smelter slag, air quality control system baghouse dust? C. Discarded barrels, drums or tanks? D. Contamination resulting from migration of substances from other properties? V FILL MATERIALS Is there currently or to the best of your knowledge has there previously been on the site any deposit of (please mark the appropriate column opposite the question): A. Fill dirt, soil, gravel, sand or like materials from a contaminated site or from a source used for any of the activities listed under Schedule 2? B. Discarded or waste granular materials such as sand blasting grit, asphalt paving or roofing material, spent foundry casting sands, mine ore, waste rock or float? C. Dredged sediments, or sediments and debris materials originating from locations adjacent to foreshore industrial activities, or municipal sanitary or stormwater discharges? YES NO VI WASTE DISPOSAL Is there currently or to the best of your knowledge has there previously been on the site any landfilling, deposit, spillage or dumping of the following materials (please mark the appropriate column opposite the question): A. Materials such as household garbage, mixed municipal refuse, or demolition debris? YES NO B. Waste or byproducts such as tank bottoms, residues, sludge, or flocculation precipitates from industrial processes or wastewater treatment? C. Waste products from smelting or mining activities, such as smelter slag, mine tailings, or cull materials from coal processing? D. Waste products from natural gas and oil well drilling activities, such as drilling fluids and muds? E. Waste products from photographic developing or finishing laboratories; asphalt tar manufacturing; boilers, incinerators or other thermal facilities (e.g. ash); appliance, small equipment or engine repair or salvage; dry cleaning operations (e.g. solvents); or from the cleaning or repair of parts of boats, ships, barges, automobiles or trucks, including sandblasting grit or paint scrapings? 4
VII TANKS OR CONTAINERS USED OR STORED, OTHER THAN TANKS USED FOR RESIDENTIAL HEATING FUEL Are there currently or to the best of your knowledge have there been previously on the site any (please mark the appropriate column opposite the question): A. Underground fuel or chemical storage tanks other than storage tanks for compressed gases? B. Above ground fuel or chemical storage tanks other than storage tanks for compressed gases? YES NO VIII HAZARDOUS WASTES OR HAZARDOUS SUBSTANCES Are there currently or to the best of your knowledge have there been previously on the site any (please mark the appropriate column opposite the question): A. PCB-containing electrical transformers or capacitors either at grade, attached above ground to poles, located within buildings, or stored? B. Waste asbestos or asbestos containing materials such as pipe wrapping, blown-in insulation or panelling buried? C. Paints, solvents, mineral spirits or waste pest control products or pest control product containers stored in volumes greater than 205 litres? YES NO IX LEGAL OR REGULATORY ACTIONS OR CONSTRAINTS To the best of your knowledge are there currently any of the following pertaining to the site (please mark the appropriate column opposite the question): A. Government orders or other notifications pertaining to environmental conditions or quality of soil, water, groundwater or other environmental media? B. Liens to recover costs, restrictive covenants on land use, or other charges or encumbrances, stemming from contaminants or wastes remaining onsite or from other environmental conditions? C. Government notifications relating to past or recurring environmental violations at the site or any facility located on the site? YES NO X ADDITIONAL COMMENTS AND EXPLANATIONS (Note 1: Please list any past or present government orders, permits, approvals, certificates and notifications pertaining to the environmental condition, use or quality of soil, surface water, groundwater or biota at the site. Note 2: If completed by a consultant, receiver or trustee, please indicate the type and degree of access to information used to complete this site profile. Attach extra pages, if necessary): 5
XI SIGNATURES The person completing the site profile states that the above information is true based on the person's current knowledge as of the date completed. Signature of person completing site profile Date completed: (YY-MM-DD) XII OFFICIAL USE Local Government Authority Reason for submission (Please check one or more of the following) Soil removal Subdivision application Zoning application Development permit Variance permit Demolition permit Date received: Local Government contact : Name Agency Address Date submitted to Site Registrar: Date forwarded to Director of Waste Management: Telephone Fax Director of Waste Management Reason for submission (Please check one or more of the following) Under Order Site decommissioning Foreclosure Date received: Assessed by: Name Investigation Required? Decision date: Region Telephone Fax If site profile entered, SITE ID # YES NO Site Registrar Date received: Entered onto Site Registry by: SITE ID #: Entry date: 6