Northwest Territories Waters Regulations (SOR/93-303)

Regulations are current to 2013-04-29 and last amended on 2012-11-30. Previous Versions

SCHEDULE III

(Subsection 6(1))

APPLICATION FOR LICENCE, AMENDMENT OF LICENCE, OR RENEWAL OF LICENCE

APPLICATION/LICENCE NO:
(amendment or renewal only)
1.NAME AND MAILING ADDRESS OF APPLICANT

  • 2. ADDRESS OF HEAD OFFICE IN CANADA IF INCORPORATED

TELEPHONE: FAX:

TELEPHONE:FAX:

3.LOCATION OF UNDERTAKING (describe and attach a map, indicating watercourses and location of any proposed waste deposits)
Latitude Longitude
4.DESCRIPTION OF UNDERTAKING (describe and attach plans)
5.TYPE OF UNDERTAKING
1. Industrial 4. Power 6. Conservation
2. Mining and milling 5. Agriculture 7. Recreation
3. Municipal
8. Miscellaneous (describe)
6.WATER USE
To obtain water Flood control
To cross a watercourse To divert water
To modify the bed or bank of a watercourse To alter the flow of, or store, water
Other (describe)
7.QUANTITY OF WATER INVOLVED (litres per second, litres per day or cubic metres per year, including both quantity to be used and quality to be returned to source)
8.WASTE DEPOSITED (quantity, quality, treatment and disposal)
9.OTHER PERSONS OR PROPERTIES AFFECTED BY THIS UNDERTAKING (give name, mailing address and location; attach list if necessary)
10.PREDICTED ENVIRONMENTAL IMPACTS OF UNDERTAKING AND PROPOSED MITIGATION
11.CONTRACTOR AND SUB-CONTRACTORS (names, addresses and functions)
12.STUDIES UNDERTAKEN TO DATE (attach list if necessary)
13.PROPOSED TIME SCHEDULE
Start date Completion date

NAME  (Print)TITLE  (Print)SIGNATUREDATE

FOR OFFICE USE ONLY
APPLICATION FEE         Amount: $ Receipt No.:
WATER USE DEPOSIT   Amount: $ Receipt No.: