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INDUSTRIAL/COMMERCIAL DEVELOPMENTS Box 69, 4912 50 Ave, Kitscoty, AB T0B 2P0 DEVELOPMENT PERMIT APPLICATION (PART A) INFORMATION AND CHECKLIST REQUIREMENTS A Development Permit Application will only be processed when it is completed in its entirety. This checklist must be completed by the applicant and attached to the Development Permit Application in order for the application to be considered complete. All boxes should be checked and the required information attached to the application. All boxes must either be a or N/A (not applicable). Required Information Completed Development Permit Application Form (Please put N/A in spaces which are not applicable); Applicant and/or Landowner Signatures. The applicant is the person applying for the permit and may be the landowner; Completed Letter of Authorization Form signed by the landowner if the applicant is not the registered landowner; Application fee, payable by cheque, debit, money order or cash payable to County of Vermilion River. Contact Development Dept. for Fee Schedule; Current Certificate of Title of subject lands (obtained from a Registries office within 30 days prior to the application); A copy of an approved Department of Highways Permit if required; Signed County of Vermilion River Development Agreements if required; Any Storm Water Management Plans, Wetland Assessments or any other Engineering reports required by the Development Officer; A legible Site Plan or Real Property Report showing all of the necessary features as listed in this application form; A legible Set of Building Drawings showing; floor plans (size of building, number of floors, number of rooms), and Elevation (building height), MUST BE submitted to the County in Digital format. A legible Surrounding Land Use Map representing the land use 1/2 a mile adjacent to the 1/4 Section of the proposed development; The box for the Right of Entry for site inspection on the property must be checked off and signed by the landowner and the applicant; and If applicable, a completed Home Occupation Application Form. A completed application will include the following information: nature of the home occupation: provide a detailed description of the nature of the business: services provided, products manufactured, items repaired, goods offered for sale; identification of existing or proposed buildings that the home occupation will occupy and the area which will be occupied for the proposed business; employees - the number of resident and non-resident employees that will work on the site, hours and days of operation; vehicles used in the operation of the home occupation, including type (i.e. commercial vehicles), size, and parking available;

traffic generation - anticipated number of client or customer visits to the home occupation per hour per day; equipment used in the operation of the home occupation and storage of materials, including outdoor storage; and signage - an indication of potential signage related to the business and the size, location and type of such signage on the property. Please note that a Development Permit is required for any signage. Must be provided for abandoned well site(s): A listing of the abandoned well sites including coordinates Identification of abandoned well site locations and the necessary setback area on the sketch accompanying this application. Signed form confirming the check for abandoned well sites and the indication of such sites on the sketch plan. o Part A Statement regarding NO wells on the subject property o Part B Statement regarding ABANDONED wells on the subject property Further information regarding abandoned wells can be obtained from the following website listed below: http://www.eub.gov.ab.ca/directives/directive079.pdf http://www.municipalaffairs.alberta.ca/documents/msb/information_bulletin_05_12.pdf http://environment.alberta.ca/01520.html IMPORTANT INFORMATION Note: A Development Permit is a document authorizing a development issued pursuant to a land use by-law. A Development Permit is required when: Constructing, substantially altering or renovating any building, garage or other accessory building; Expanding or substantially renovating your office or commercial enterprise; Opening or expanding a home occupation; Demolishing or moving a building; Changing or intensifying the use of the lot or building. If development commences prior to obtaining approval, a fine may be applied. Incomplete applications may be returned or cause delays in the processing of the application. Safety Code permits will also be required for development of any structures. Upon review, additional supportive information may be requested by the Development Officer in support of your application.

SITE PLAN OF PROPOSED DEVELOPMENT The Site Plan must include all of the following information in order for it to be considered complete; Property lines with dimensions and total area of property; Location of all existing, temporary and proposed structures (ie. dwellings, sheds, signs, etc.); Setback distances of all structures, new and existing: from the front, rear, and side yards of structures to the closest property line (front yard refers to that portion of the building facing the road); Label roadways and indicate existing and/or proposed access to the site; If applicable, location of oil & gas wells, pipelines & facilities; Indicate the location of water wells and septic tank/sewage disposal systems; If applicable, location of natural features (water courses, wooded areas, etc.) and man-made features (drainage ditches. berms, etc.); and If applicable, location of all easements such as utility right of way, caveat, etc. Abandoned well site(s) location LANDSCAPING PERMIT (PART B) Upon the request of the Development Officer a landscape plan shall be submitted with the development permit application and/or as a Separate Permit. The Plan shall show all present and proposed physical features, including berms, slopes, retaining walls, shrubs and trees and a site grading plan. All plant species must be identified and in the case of trees, their height and diameter must be shown of the plan. With the exception of sites proposed for single family dwellings, sites proposed for development shall be landscaped to the satisfaction of the Development Officer, having regard to the following objectives: Enhancement of aesthetics; The separation of incompatible uses; The creation of privacy; The reduction of glare; The reduction of noise; The improvement of micro-climatic conditions; The controlling of erosion and drifting of snow; The enhancement of wildlife habitats; Site Grading Plan; showing soft & hard landscaping, adequate surface drainage and existing and proposed topography Such other objectives as the Development Officer considers advisable.

1. Please use the above square to represent the development area where development may occur and show its dimensions. (in the case of multi-lot subdivisions, use the above square to represent your entire lot.) 2. Indicate where buildings and signs are and identify the distances from all property boundaries. Also show the distance between all buildings and property lines. (from the closest point of structure to closest point of another structure and/or property lines) 3. Include the location of all roads and/road allowances. Show the location of the access(s) to your property. 4. Include shelterbelts, septic systems, utility lines, water courses, steep slopes or any other feature used to determine the location of the proposed development. 5. Measurements must be recorded in either meters or feet. (other units will not be accepted) 6. Site plan must be legible and to scale to the satisfaction or the development officer.

ELEVATION PLAN NOTES: Measurements must include height of buildings from highest point of grade to peak of building and underside of eaves.

LETTER OF AUTHORIZATION Note: This form must accompany all applications where the applicant is not the landowner. PLEASE ENSURE THAT ALL NAMES AND SIGNATURES OF THOSE LISTED ON THE CERTIFICATE OF TITLE ARE INCLUDED. I/We being the registered owner(s) of: All/part of the 1/4 Section Township Range West of 4 Lot: Block: Plan: Do hereby authorize: to act as Applicant on my/our behalf regarding the application of the above mentioned lands: Name of Applicant(s): Address: Postal Code: Phone #: Alternate Phone #: Fax #: E-mail: Landowner Signature Date Landowner Signature Date If the landowner is a registered company, documentation of those with signing authority under company seal is required in addition to this form.

DEVELOPMENT PERMIT APPLICATION CONTACT DETAILS NAME OF APPLICANT: Address: Postal Code: Phone #: Fax #: Alternate Phone #: E-mail: LANDOWNER(S) (if applicant is not the landowner): Address: Postal Code: Phone #: Fax #: Alternate Phone #: E-mail: SITE INFORMATION & DEVELOPMENT DETAILS LEGAL: (Circle one) NE NW SE SW 1/4 Section Township Range W4 Lot Block Plan TITLE AREA: hectares or acres Roll Number EXISTING BUILDINGS (including number of dwellings) DETAILS OF PROPOSED DEVELOPMENT: Cost of project: Land Use District: Safety Codes Provider: (please indicate choice below) Superior Safety Codes Inc.** The Inspections Group Inc.** **The Provider the Applicant indicates above will be required to be used for the duration of development and is applicable to all disciplines within Safety Codes this helps in tracking any future safety codes issues for your development.**

PROPOSED CONSTRUCTION DETAILS - IF APPLICATION IS FOR A STRUCTURE TYPE OF STRUCTURE: Dwelling Garage Other (e.g. shop) Square Footage: Building Height: Footings: Foundation: Exterior Finish: Roofing Material: PROPOSED DEVELOPMENT SETBACKS (indicate distance and circle applicable direction): Front Property Line: N S E W Rear Property Line: N S E W Side Property Line: N S E W Side Property Line: N S E W *For "Move-On" Dwelling (Please submit photographs of the building to be moved): Year Built: Name of Mover: Present Location of Dwelling: *For Mobile Home: Size: Year: Model: Serial Number: Name/Make of Unit: OTHER DETAILS Please indicate if there are any of the following uses within one (1) mile of the proposed development: Gas Facilities/Pipelines Yes No Unknown Distance Confined Feeding Operations Yes No Unknown Distance: Please indicate the type of Sewage System that is existing or proposed: Septic Field Holding Tank Open Discharge Other (please describe) Please indicate the type of Water Supply that is existing or proposed: Well Cistern Common Other (please describe)

IF APPLICABLE PLEASE RETURN WITH DEVELPOMENT PERMIT APPLICATION GENERAL INFORMATION REQUIRED FOR A FACTORY BUILT HOME (To be completed fully and attached to the Development & Building Permit application form.) C.S.A. Label Number (located on the 1. electrical panel): 2. Alberta Labour Label Number: 3. Make / Name of Unit: 4. Year of Manufacture: 5. Serial Number: 6. Model Number: 7. Size of Unit: Yes No 8. Manufacturer Blocking Instructions Available: (If Yes Please Provide) Legal Land: Part of Section Township Range W4 9. Lot Block Plan 10 Development Permit Number: GENERAL INFORMATION REQUIRED FOR NEW ADDITIONS Roofing Roof Sheathing Rafters Wall Sheathing Studs Insulation Vapour Barrier Wall Finish Skirting Insulation Ceiling Joist Vapour Barrier Ceiling Finish Underlay Subfloor Floor Joist At on center. Beam Blocking Existing Mobile Home

Please Note; When considering a development within the County, please keep in mind that there may be costs associated with upgrading road allowances to serve your development. Section 650 (1) of the Municipal Government Act states that A Council may in a land use bylaw require that, as a condition of a development permit s being issued, the applicant enter into an agreement with the municipality to do any or all of the following: (a) to construct or pay for the construction of a road required to give access to the development. Additionally, County policy PD 003 states that the County is not obligated to provide, build or upgrade an access to any parcel or ¼ section of land. If you have concern over whether your road will require upgrades please contact the Planning and Development Department or the Public Works Department. I, the undersigned, agree that I have read and understand the requirements of this application and those responsibilities that may apply to this development SKETCH DISCLAIMER I hereby acknowledge that the sketch provided is for the purposes of processing a development permit application only. The site plan has been prepared with information provided by the applicant. Accordingly, the County of Vermilion River is not responsible for the accuracy of the sketch or any other information contained herein. Print Name (here) Applicants Signature Date Print Name (here) Applicants Signature Date

RIGHT OF ENTRY AGREEMENT I hereby grant approval for County of Vermilion River staff to access the property for a Site Inspection: Yes No REGISTERED OWNER(S) AND/OR PERSON ACTING ON THE REGISTERED OWNER'S BEHALF: I, hereby certify that: (Print full name/s) I am the registered owner I am authorized to act on behalf of the registered owner and that the information given on this form is full and complete and is, to the best of my knowledge, a true statement of the facts relating to this application for Development approval. Applicant(s) Signature Date Note: If landowner is a registered company, we require documentation of those with signing authority under company seal.

ABANDONED OIL AND GAS WELLS Where a development is planned, a search for abandoned wells in the vicinity of the proposed development area MUST be conducted. Identification by the landowner or agent acting on behalf of the landowner ensures that they are aware of any abandoned wells within or surrounding the development area. By having the landowner or agent acting conduct this search it can prevent damage both to the well and to construction or excavation equipment, as well as injury to equipment operators or landowners. The LAND OWNER or agent acting on behalf of the landowner, must contact all licensees on the affected property. The licensee is then required to physically locate the abandoned well(s). a. GPS coordinates of the well site(s); and b. A sketch of the site showing the exact location of the well(s) on the site and the required setback distance from the wellbore. If the abandoned well licensee no longer exists or is non-operational. The ERCB and Orphan Well Association (www.orphanwell.ca) have reached an agreement whereby the Orphan Well Association will, when contacted by a Landowner/agent, go out and locate the abandoned well on the property as per the regular responsibility of licensees. Further information can be found at the Orphan well Association website listed above. The County of Vermilion River CANNOT OPEN NEW APPLICATIONS until all relevant information regarding abandoned oil and gas wells has been provided by the landowner/agent. The costs of locating any abandoned oil and gas well(s) is the responsibility of the licensee. This process may add additional time in the preparation of an application, but will not incur direct expenses on the landowner. Further information can be viewed at http://www.municipalaffairs.alberta.ca/documents/msb/information_bulletin_05_12.pdf http://www.eub.gov.ab.ca/directives/directive079.pdf Information about abandoned well locations can be obtained http://environment.alberta.ca/01520.html

In order to demonstrate that this has occurred, The County of Vermilion River will require the following: a listing of the abandoned well sites including the coordinates(utm or Lat/Long), identification of abandoned well site locations and the necessary setback area on the sketch accompanying the application, a statement confirming that the abandoned well sites are marked with onsite identification. Well Listing: PART A: Statement regarding NO wells on the subject property: I (please print), registered owner (or their agent) of, have consulted the Energy Resources Conservation (Legal land description) Board (ERCB) Abandoned Well Map Viewer, and verified that THERE ARE NO ABANDONED wells located on the property subject to this application. A COPY OF THE ERCB MAP SHOWING THE SUBJECT PROPERTY IS ATTACHED. Signature of registered owner (or agent) Date

PART B: Statement regarding ABANDONED wells on the subject property: I (please print), registered owner (or their agent) of, have consulted the Energy Resources Conservation (Legal land description) Board (ERCB) Abandoned Well Map Viewer, and verified that ABANDONED WELLS ARE LOCATED on the property subject to this application. I have contacted the responsible licensee(s), and the exact well location(s) has/have been confirmed. **INFORMATION SHEET IS ATTACHED SHOWING EXACT LOCATIONS** Additional information provided by the licensee(s) requiring a change in the setback area is attached: Yes Not applicable In the event that construction activity occurs within the setback area of the abandoned well(s) as a result of development on the subject property, the abandoned well(s) will be temporarily marked on-site with identification to prevent contact during construction. A copy(s) of the ERCB map showing the subject property and a list of identifying and locating the abandoned well(s) and on the subject property and a list are attached. Signature of registered owner (or agent) Date

SITE PLAN OF PROPOSED DEVELOPMENT North The square below may be used to represent a 1/4 Section North Indicate name of ROAD if applicable Indicate name of ROAD if applicable Indicate name of ROAD if applicable Indicate name of ROAD if applicable Scale: 1 square = feet or meters (please circle)