Mackenzie Valley Federal Areas Waters Regulations (SOR/93-303)

Regulations are current to 2018-09-26 and last amended on 2016-06-13. 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

    TELEPHONE: blank line FAX: blank line

  • 2 ADDRESS OF HEAD OFFICE IN CANADA IF INCORPORATED

    TELEPHONE:blank lineFAX:blank line

  • 3 LOCATION OF UNDERTAKING (describe and attach a map, indicating watercourses and location of any proposed waste deposits)

    Latitude blank lineLongitude blank line

  • 4 DESCRIPTION OF UNDERTAKING (describe and attach plans)

  • 5 TYPE OF UNDERTAKING

    • 1 Industrialblank line

    • 2 Mining and millingblank line

    • 3 Municipalblank line

    • 4 Powerblank line

    • 5 Agricultureblank line

    • 6 Conservationblank line

    • 7 Recreationblank line

    • 8 Miscellaneous (describe) 8. blank line

  • 6 WATER USE

    • To obtain water blank line
    • To cross a watercourse blank line
    • To modify the bed or bank of a watercourse blank line
    • Flood control blank line
    • To divert water blank line
    • To alter the flow of, or store, water blank line
    • Other (describe) blank line
  • 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 blank lineCompletion date blank line

NAME  (Print)blank lineTITLE  (Print)blank lineSIGNATUREblank lineDATE

For Office Use Only

APPLICATION FEE         Amount: $ blank lineReceipt No.: blank line

WATER USE DEPOSIT   Amount: $ blank lineReceipt No.: blank line

 
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