3300 Wishart Road | Colwood, BC | V9C 1R1 | 250 294-8153 | www.colwood.ca

Application No.____________

Office Use Only

APPLICATION FOR A PERMIT

I/We hereby make application under the provisions of Part 26 of the Local Government Act for a (check where applicable) Development Permit Development Variance Permit Temporary Commercial Permit Temporary Industrial Permit Master Development Permit

to permit the proposed development as described in the attached form upon (Legal Description of Property):

and located at (street address or general location)

Required application fee and the completed Information forms are attached. (Date) (Applicant's Signature) THIS APPLICATION IS MADE WITH MY FULL KNOWLEDGE AND CONSENT Registered Owner’s Name (please print) Date Registered Owner's Signature WHERE THE APPLICANT IS NOT THE REGISTERED OWNER THE APPLICATION MUST BE SIGNED BY

THE REGISTERED OWNER

PERMIT APPLICATION FORM

Notice of Collection of Personal Information The information in this form is collected in compliance with the Freedom of Information and Protection of Privacy Act (FOIPPA). If you require further information regarding FOIPPA, please contact the City of Colwood FOI Coordinator at 250-478-5999 or the Information and Privacy Commissioner at 1-800-663-7867. 1. APPLICANT AND REGISTERED OWNER INFORMATION

1.1 Applicant's Name Address Postal Code Email Telephone: Business Home FAX

1.2 Registered Owner's Name

Address Postal Code Email Telephone: Business Home FAX A copy of a State of Title Certificate dated no more than 30 days prior to submission of the application must accompany the application as a proof of ownership. Also include copies of any restrictive covenants or easements. 2. APPLICATION FEE An Application Fee as set out in Schedule "B" shall be made payable to the City of Colwood and shall accompany the application.

3. SUBJECT PROPERTY AND DEVELOPMENT 3.1 Full Legal Description of land(s):

3.2 Location (street address of property, general description or map):

3.3 Current Zoning: 3.4 Description of the Existing Use/Development:

3.5 Full Description of the Proposed Development (use separate sheet if necessary):

3.6 Proposed Variation and/or Supplementation to Existing Regulations (use separate

sheet if necessary):

3.7 A statement explaining how the Application complies with the relevant development

permit guidelines (use separate sheet if necessary):

3.8 Reasons and Comments in Support of the Application (use separate sheet if necessary)

4. ATTACHMENTS With a Development Permit application one digital set of full size plans and two printed sets of full size plans, showing the following are required: a) A dimensioned Sketch Plan showing the parcel(s) or part of the parcel(s) and the location of

existing buildings, structures and uses. b) A dimensioned Site Development Plan showing the proposed use, buildings and structures,

highway access, parking, landscaping, and open spaces. c) A Contour Map with a maximum 2-metre contour interval.

d) A dimensioned Sketch Plan drawn to a scale of 1 to 1,000 of the proposed subdivision, where subdivision is contemplated.

e) All elevations to Min. 1:100 scale indicating line of finished ground, existing and average

grades at building wall and, and for projects where existing grade is altered, at all bordering properties and streets;

f) Specification of exterior treatment on all elevations identifying materials, providing colours

and colour chips;

g) Landscaping plans specifying the nature and location of surface materials, species, size, number, and spacing of trees, shrubs and plants, and locations of vents, refuse and recycling containers and irrigation systems, and noting any trees that are to be removed, together with the location and treatment of walls and fences and the proposed lighting concept;

h) Sections through building indicating line of finished, existing and average grade;

i) Number of parking spaces and loading spaces required and provided, including access,

layout and dimensions;

j) Roof plans showing treatment of all exposed surfaces, including vents, chimneys and elevator housing; and

k) Off-site information as may be material to the design: e.g. boulevard trees, adjacent parks,

sidewalks, street furnishings, or overhead utilities.

l) The Director of Planning may require additional information, relevant to the scale and visual impact of the proposal, e.g. models, coloured perspective, and photographs.

With a Development Permit application for land located in an environmental protection development permit area, as required, one digital set of full size plans, one digital set of reduced legible plans no larger than 28 cm x 43 cm (11” x 17”) two printed sets of full size plans, one printed set of reduced legible plans no larger than 28 cm x 43 cm (11” x17”) showing the following are required: a) A dimensioned Sketch Plan showing the parcel(s) or part of the parcel(s) and the location of

existing buildings, structures and uses. b) A dimensioned Site Development Plan showing the proposed use, buildings and structures,

highway access, parking, landscaping, and open spaces. c) A Contour Map with a maximum 2-metre contour interval.

d) A dimensioned Sketch Plan drawn to a scale of 1 to 1,000 of the proposed subdivision, where subdivision is contemplated.

e) Elevations shall be shown in metric measure above geodetic datum. All survey work shall be

tied in to a geodetic survey monument (benchmark) and the reference benchmark and elevation shall be shown on the drawings.

f) Elevations of existing and proposed basement floors, and finished grades around buildings,

shall be shown. g) All existing registered easements and rights-of-way shall be shown lightly shaded on the

drawings, and permitted uses specified. h) All proposed services including curbs, sidewalks, sewers, drains, gas, water, and underground

wiring and poles shall be drawn on one plan and appropriately identified. i) Existing watermains, sanitary sewer mains, storm drains (including all appurtenances), ditches,

pavement, curbs, sidewalks, underground wiring, underground ducting, poles, trees, and service connections shall be indicated on the drawings in plan and profile.

j) All dimensioning on the drawings shall be given from an existing or proposed iron pin or lot

line. k) The normal high water mark and two hundred year high water mark of natural bodies of water

shall be shown on the drawings. l) Proposed construction shall be indicated with heavy dashed lines and existing construction

shall be indicated with solid lines. m) A 1:500 horizontal and a 1:50 vertical scale is usually required. Details may be provided in a

larger scale and cross sections shall be provided in a horizontal scale of 1:100 and a vertical scale of 1:100.

The following information regarding sewers and drains shall be shown on the plan and profile:

I. Size, type, and class of pipe; II. Percentage grade to two decimal points;

III. Invert elevations at both inlet and outlet of manholes; IV. Information on any vertical curves; and V. Existing sewer drain and water supplies.

The drawing illustrating proposed sewers and drains shall provide information on horizontal curves, pipe offsets from property line, and the grade of the connection from the upper end of the drop to the manhole if other than 2%.

The design calculations for the sanitary sewer system and the storm drainage system, including detailed design drawings for any proposed oil/water separators, and any proposed in-ground disposal and treatment facilities shall be included in the submission. Where in-ground sewage disposal systems are proposed, a field investigation report certified by a Professional Engineer shall be provided for the project indicating the following:

I. Location of all observation pits and percolation test holes referenced to existing or proposed property lines;

II. The results of a minimum of four percolation tests within the proposed sewage disposal

field on each proposed lot;

III. Soil logs submitted in profile form to a minimum depth of two metres below existing ground elevation indicating the type and depth of soils and depth to groundwater and impervious layers;

IV. A scale plan showing the lot dimensions, proposed building envelope, location of driveway,

location of water service, location of storm drainage, and location of the sewage treatment and sewage disposal system;

V. A drawing indicating the off-set distances from the limits of the sewage disposal system to

the property lines, the spacing and dimensions of the disposal lines in the system, and location of all curtain drains required;

Where it is proposed to use any form of soil-retaining structure to maintain slope stability and improve the efficiency of the sewage disposal system, the location of the structure and the Professional Engineer's certification that the drainage for such a structure has been adequately provided for;

I. Detailed design drawings of the proposed sewage treatment and disposal system including technical support information;

II. Any areas which are proposed to have a cut or fill greater than 0.3 metres, and for those

areas appropriate cross sections indicating the cutting or filling shall be provided in typical format; and

III. Any areas in which trees or other vegetation are to be preserved shall be clearly indicated.

APPLICATION FEES

Application Type Land Use Zone Type/Density Proposed Application Fees

Amendment to the Official Community Plan (OCP) or the Land Use Bylaw (Rezoning)

All Zones $3,400 +$0.20/m2 Lot Area <5,000 m2 +$0.10/m2 Lot Area >5,000 m2

Text Amendment All Zones $2,000

Joint OCP-Rezoning Amendment All Zones

OCP Amendment Fee + $2,000

Temporary Use Permit All Zones $2,000

Public Hearing Fee All Zones $2,200

Development Permit (DP) Form & Character (F&C)

Minor Exterior Renovations* $500

0–100m2 Building Floor Area All Zones

$1,000

>100m2 Building Floor Area All Zones

$2,800 + $0.50/m2 Building Floor Area

Development Permit (DP) Environmental Protection (EP)

0–150m2 Land Alteration Area (Non-riparian)

$200

Up to 1000m2 Land Alteration Area $1,500

1001m2–4500m2 Land Alteration Area

$3,500

4501m2–25,000m2 Land Alteration Area

$5,500

>25,000m2 Land Alteration Area $7,500

DP+Add Per Variance Req’d All Zones $250

DP+ (Joint F&C – EP) All Zones DP F&C Fee + 0.5(DP-EP Fee)

Development Variance Permit (DVP)

All Zones $1,500 + $250/ Additional Variance Required

Strata Conversion All Zones $500/strata lot

Maximum Fee Cap (Excluding rezoning or amendments to the OCP)

All Zones $35,000

*Minor exterior renovations of existing intensive residential (including duplex) and multi-family residential buildings that change the form and character of a building or buildings over $10,000 construction value, to a cap of $30,000.

Development Application Signs

As the applicant, you are required to ensure signs advertising the proposed development are posted on the land that is subject to the application.

Please be advised that it is Council policy that the following steps are to be followed with respect to OCP and zoning amendments, development permit and development variance permit applications.

1. Signs are to be erected on each street frontage.

2. Signs are to be posted no higher than 2 metres (6.6 ft.) above the grade of the road and nofurther back from the road right-of-way than 3 metres (10 ft.).

3. In the case of your application, signs for development permits are to be posted as soon aspossible and in the event your application is forwarded to Committee or Council forconsideration the sign must be posted prior to the City sending out notification of yourdevelopment to surrounding property owners/occupiers and remain posted until after thepermit is issued.

4. Once the signs are posted, you are required to send us by email a picture of the postedsign(s) with the posting date and location documented (to planning@colwood.ca).

Also, for your convenience, please find the names and contact information of three local businesses that make advertising signs.

1. The SignPad2675 Wilfert Road, Colwood, BC V9B 6M3250-590-7785info@thesignpad.com

2. TranSign2920 Jacklin Road, Langford, BC V9B 3Y5250-478-9531info@transign.com

3. Speedpro Signs1610 Island Highway, View Royal, BC V9B 1H8250-474-5234signs@speedprowestshore.com

3300 Wishart Road | Colwood, BC | V9C 1R1 | 250 294-8153 | www.colwood.ca

The information in this form is collected in compliance with the Freedom of Information and Protection of Privacy Act (FOIPPA). If you require further information regarding FOIPPA, please contact the City of Colwood FOI Coordinator at 250-478-5999 or the Information and Privacy Commissioner at 1-800-663-7867.

WASTE MANAGEMENT ACT SITE PROFILES

The Waste Management Amendment Act, 1993, came into effect on April 1, 1997. The Act creates a system for screening properties for possible contamination. It uses site profiles that require information about the past and present uses of the site, as well as basic land descriptions. Please indicate what type of application you are making: _____ Zoning _____ Development Permit _____ Development Variance Permit _____ Temporary Commercial Permit _____ Temporary Industrial Permit _____ Master Development Permit The attached Site Profile Form is provided for your information and use. If you will not be submitting a Site Profile Form, please sign below to indicate you are aware of the regulations and that you do not consider them applicable to your application.

___________________________ Signature of Applicant For further information, please contact: Ministry of Environment Vancouver Island Regional Office 2080 - A Labieux Road Nanaimo, BC V9T 6J9 Telephone: (250) 751-3100 Fax: (250) 751-3103

Regional Offices

Vancouver Island Region

2080 Labieux Road

Nanaimo, B.C. V9T 6J9

Cariboo Region

400-640 Borland Street

Williams Lake, B.C. V2G 4T1

Lower Mainland Region

2nd Floor, 10470-152nd Street

Surrey, B.C. V3R 0Y3

Skeena Region

PO Box #5000

3726 Alfred Avenue

Smithers, B.C. V0J 2N0

Thompson Region

1259 Dalhousie Drive

Kamloops, B.C. V2C 5Z5

Omineca Region

4051 18th Avenue

Prince George, B.C. V2N 1B3

Kootenay Region

205 Industrial Road G.

Cranbrook, B.C. V1C 7G5

401-333 Victoria Street

Nelson, B.C. V1L 4K3

Phone: 250 354-6333

Fax: 250 354-6332

Okanagan Region

102 Industrial Place

Penticton, B.C. V2A 7C8

Peace Region

400-10003 110 Avenue

Fort St. John, B.C. V1J 6M2

SCHEDULE 1

Site Profile

Version 4.0

Introduction

Under section 40 of the Environmental Management Act,a person who knows or reasonably should know that a site has been used oris 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 siteprofile requirements apply.

Ifsection 40 ofthe Environmental ManagementAct applies toyou andyou know or reasonably should know that the site has beenused or is usedfor one ofthe purposes or activities found in Schedule 2 ofthe ContaminatedSites Regulation, you may be requiredtocompletethe 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 sectionXI. If the site profile is not satisfactorily completed, it will not be processed under the Environmental Management Act and theContaminated Sites Regulation. Failure to complete the site profile satisfactorily may result in delays in approval of relevantapplications 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 ofyour knowledge.

Section 27 (1) of the Freedom of Information and Protection of Privacy Act requires that provision of personal informationconcerning an individual must be authorized by that individual. Persons completing the site profileon behalfof the site ownermust be authorized by the site owner.

One(1) site profile may be completed for a site comprised of more thanone titledor untitled parcel, but individual parcels must beidentified.

The latitude and longitude (accurateto 0.5 of a second usingNorth American Datum established in 1983)of the centreof the sitemust be provided. Also, please attach an accurate map, containing latitude, longitude and datum references, which shows theboundaries 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)mustbe provided for each parcel as well as the appropriate legal description.

If the property is untitled Crown land (no PIDnumber), then theappropriate PIN numbers (Parcel Identification Numbers - CrownLand 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 thissiteprofile will become part of the public record and may bemade available to thepublicthrough the Site Registry as established under the Environmental Management Act.

Undersection43 of the Environmental Management Act, corporate and personal information contained in the site profilemay bemade available to the public through the'Site Registry. If you have questions concerning the collection of this information, contactthe SiteRegistrar, at site(a>gov.bc.ca. Forquestions on site profiles, please senda message to siteprofilesf^gov.bc.ca.

I CONTACT IDENTIFICATION

A. Name of Site Owner:

Last

Company.

Owner's Civic Address.

City

Country,

First Middle Initial(s)

Province/State

Postal Code/ZIP

B. Person Completing Site Profile (Leave blank if same as above):

Last First Middle Initial(s).

Company.

C. Person to Contact Regarding the Site Profile:

Last First

Company.

Mailing Address.

City

Country.

Telephone ( )

II SITE IDENTIFICATION

.Middle Initial(s).

Province/State

Postal Code/ZIP.

Fax ( ) _

Please attach a site location map

All Property

Coordinates (usingthe NorthAmerican Datum 1983 convention) for the centreof the site:Latitude: Degrees Minutes SecondsLongitude: Degrees Minutes Seconds

Pleaseattach a map ofappropriate scale showing the boundariesof the site.

For Legally Titled, Registered Property

Site Street Address (if applicable)

City

-2-

Postal Code

(and/or, if applicable)

(and/or, if applicable)

(and/or, if applicable)

PID numbers andassociated legal descriptions. Attach anadditional sheet ifnecessary.

PIP Legal Description

Total number oftitled parcels represented by this site profile is:

For Untitled Crown Land

PIN numbers and associated Land Description. Attach an additionalsheet ifnecessary.

PIN Land Description

Total numberof untitled crown land parcels representedby this site profile is:.

(and, if available)

Crown land file numbers. Attach an additional sheet ifnecessary.

Ill COMMERCIAL AND INDUSTRIAL PURPOSES OR ACTIVITIES

Please indicate below, in the format of the example provided, which of the industrial and commercial purposes andactivities fromSchedule 2 have occurred or are occurring on this site.

EXAMPLE

Schedule 2 Description

Reference

El appliance, equipment or engine repair, reconditioning, cleaning or salvageF10 solvent manufacturing or wholesale bulk storage

Pleaseprintlegibly. Attach an additional sheet ifnecessarySchedule 2 Description

Reference

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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 qualitycontrol system baghouse dust?

C. Discarded barrels, drums or tanks?

D. Contamination resulting from migration ofsubstances from other properties?

V FILL MATERIALS

Is there currently or to the best of your knowledge has there previously been on the site anydeposit of (please mark the appropriatecolumn opposite the question):

YES NO

A. Fill dirt, soil, gravel, sand or like materials from a contaminatedsite or from a source used for any of theactivities 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. Dredgedsediments, or sedimentsand debris materials originating from locationsadjacent to foreshoreindustrial activities, or municipal sanitary or stormwater discharges?

VI WASTE DISPOSAL

Is there currently or to the best of your knowledge has there previously been on the site anylandfilling, deposit,spillageor dumping of the following materials (please mark the appropriatecolumn opposite the question):

YES NO

A. Materialssuch as household garbage,mixedmunicipal refuse,or demolition debris?

B. Waste or byproducts such astank bottoms, residues, sludge, or flocculation precipitates from industrialprocessesor wastewater treatment?

C. Waste products from smelting ormining activities, such assmelter slag, mine tailings, or cull materialsfrom coal processing?

D. Waste products from natural gasand oilwell drilling activities, such asdrilling fluids and muds?

E. Waste products from photographic developing or finishing laboratories; asphalt tar manufacturing;boilers, incinerators or otherthermal facilities (e.g. ash); appliance, small equipment or engine repair orsalvage; drycleaning operations (e.g. solvents); or from thecleaning or repair of parts of boats, ships,barges, automobiles or trucks, including sandblasting gritor paint scrapings?

VII TANKS OR CONTAINERS USED OR STORED, OTHER THAN TANKS USED FORRESIDENTIAL 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):

YES NO

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?

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):

YES NO

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 orpanelling buried?

C. Paints, solvents, mineral spirits or waste pest control productsor pest control product containersstored in volumes greater than 205 litres?

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):

YES NO

A. Governmentorders or other notificationspertainingto 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, stemmingfrom contaminants or wastes remaining onsite or from other environmental conditions?

C. Government notifications relating to past or recurring environmental violations at the site or anyfacility located on the site?

X ADDITIONAL COMMENTS AND EXPLANATIONS

(Note 1:Please listanypastor present government orders, permits, approvals, certificates andnotifications pertaining to theenvironmental condition,use or qualityof soil, surfacewater,groundwater or biota at the site.

Note 2: If completed bya consultant, receiver or trustee, please indicate thetypeanddegree of access to information used tocompletethis site profile. Attach extra pages, if necessary):

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XI SIGNATURES

The person completing the site profile states that the above information is true based on the person's current knowledge asof the date completed.

Signature of person completing site profile Date completed: (YY-MM-DD)

XII OFFICIAL USE

Local Government Authority

Reason for submission (Pleasecheck oneor more of thefollowing) Soil removal Q

Subdivision application • Zoning application • Development permit Q Variance permit Q Demolition permit •

Date received: Local Government contact

Name

Agency.

Address

Telephone Fax

Director ofWaste Management

Reason for submission (Please check one or more ofthefollowing)

Under Order Q Site decommissioning • Foreclosure •

Date received:

Date received:

Assessed by:

Name

Region.

Telephone Fax

If site profile entered, SITE ID #_

Site Registrar

Entered onto Site Registry by:

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Date submitted to

Site Registrar:

InvestigationRequired?

YES NO

SITE ID #:

Date forwarded to

Director of Waste

Management:

Decision date:

Entry date: