 |
Environment,
Energy and Forestry
Pollution
Prevention
|
Application
for a Property
Inspection
(Pursuant to the
Environmental Protection Act) |
Send application to:
Environmental Assessment Officer
Pollution Prevention Division
Environment, Energy and Forestry
PO Box 2000, Charlottetown, PE C1A 7N8
Tel: (902)368-5049; Fax: (902) 368-5830 |
CCAL Subdivision Case No:
_____________________
Date Received:
_____________________ |
Personal information on this form is collected under clause 31(c) of
the Freedom of Information and Protection of Privacy Act as
it relates directly to and is necessary for the inspection of land
relating to a proposal for subdividing. This information will be
used for the purpose of reviewing applications, contacting the
client, issuing property inspection results and maintaining
departmental records. If you have any questions about this
collection of personal information, you may contact the Director of
the Pollution Prevention Division, 11 Kent Street, Jones Building,
Charlottetown, PEI, C1A 7N8, (902) 368-5474. |
|
1.
Application Submitted by: |
|
Name of
Applicant:___________________________________________________________ |
Address of
Applicant:__________________________________________________________
____________________________________________________________________________ |
|
Postal Code: ___________________ |
|
Telephone Number(s) of applicant: Home:___________ Work:_________
Cell: _________ |
|
Fax: ____________________ Email Address:
_____________________________________ |
|
2. Location
of Proposed Subdivision: |
|
Provincial Property Number(s) ______________________________________ |
|
Community: _____________________________ County: ________________ |
3. Intended
Purpose of Subdivision:
- Residential Development
- Right of Way (ROW)
modifications
- Land Transfer to
Siblings/Dependents
- Agricultural Active
- Agricultural Idle
- Forestry
- Other
_____________________________
|
4. Septic System Information:
Type of sewer system required to service the subdivided land
parcels:
private
central
municipal
n/a |
5. Water System Information:
Type of water supply system required to service the subdivided land
parcels:
private
central
municipal
n/a |
6.
Sensitive Environmental Features:
What potentially
environmentally sensitive features exist?
wetland
watercourse
sand dune
unknown
|
7. Declaration of Applicant:
It is understood that for the purpose of an application review,
staff from the Department of Environment, Energy and Forestry at any
reasonable time may enter the property as identified in sections 2
and 3 of this application. |
Signature of Applicant _________________ |
Date:
________________ |