A B. C Submission. Subdivision Application under The Planning Act C.C.S.M. c. P80

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under The Planning Act C.C.S.M. c. P80 A Before B Application You Start Meet with a planner at your local Community and Regional Planning office to discuss your proposed subdivision. Requirements C Submission a subdivision application form with all questions answered, and signed by the registered owner and applicant a Map (submitted as a TIFF image and a hard copy) prepared by a Manitoba land surveyor showing: ties to a minimum of two survey monuments proposed lot(s) with dimensions, area and angles location of all buildings on foundations and fixed structures driveway(s) including the current and proposed access onsite wastewater management systems and distance to proposed lot lines well existing above-ground utilities existing tree line and edge of field major water bodies title search Status of Title(s) for all land to be included in the subdivision from a Manitoba land surveyor. The Status of Title(s) cannot be more than 30 days old. a cheque or money order for $510 payable to the Minister of Finance Mail or drop off the completed application form, the required application fee, map, titles, and any supporting documents to your local Community and Regional Planning office. Your application will be considered incomplete and returned if any of the above requirements outlined in Section B are missing. Refund Policy: The application fee will only be refunded if the application has not been circulated to reviewing agencies. A Map is a requirement for all subdivision applications under the Subdivision Regulation and it must be prepared by a Manitoba land surveyor. Refer to the Planning Resource Guide: Subdivision in Manitoba for more details on application and map requirements.

1Name(s): Registered Owner(s) Applicant Name(s): Address: Address: City/Town/Village: Province: Postal Code: Email: Phone (daytime): Cell Phone: City/Town/Village: Province: Postal Code: Email: Phone (daytime): Cell Phone: Your File No.: 2 Declaration I, hereby certify that I am the registered owner of the land proposed for subdivision OR am authorized to act as the registered owner and I hereby affirm that all statements contained within this application are complete and true, and I make this declaration conscientiously believing it to be true. Registered Owner(s) signature: Date: Applicant signature: Date: 3Name: Lawyer Contact Information (if applicable) Firm: Address: Your File No.: City/Town/Village: Province: Postal Code: Email: Phone: 2

4Land to be Subdivided Municipality: Roll Number: Civic Address (if any): Lot or Parcel No.: Block No.: Plan No.: Part of NW NE 1/4 of Section Township Range East West SW SE of the Principal Meridian OR River Lot No.: Parish or Settlement: 5Existing Land Use a. What is the land currently used for? (check all that apply) agriculture i. Is there a livestock operation? yes no Type of livestock: Distance to nearest property boundary: Number of animal units or animals: ii. Is there a manure storage facility? yes no Distance to nearest property boundary: commercial industrial other (ex: woodland) residential (including cottages) single family multiple family A manure storage facility means a structure, earthen storage facility, molehill, tank or other facility for storing or treating manure. b. Are there existing buildings on this land? yes no Tip: Show the location and type of all permanent buildings and onsite wastewater management systems. Show the distances to the closest new property boundary on the surveyor s subdivision application map. 3

6Proposed Land Use a. Is this a multi-phase development? yes no If yes, how many phases? Is this a multi-lot development? yes no If yes, how many lots? b. What is the intended use of the proposed lot(s)? (Check all that apply) agriculture commercial industrial other residential single family multiple family c. Are there existing buildings on the proposed lot(s)? yes no d. Describe the proposed lot(s). (Check all that apply) wooded/treed low/swampy cultivated pasture hilly level/flat near a waterbody (ex: lake, river, creek) other e. Within 1.6 kilometres (1 mile) of the proposed lot(s) is there any of the following? (Check all that apply) livestock operations If nearby, what is the type, approximate size and distance? gravel pit or quarry pipeline sewage lagoon historic site or structure airport waste disposal ground (active or inactive) 4

7 Flooding and Drainage a. Has any part of this land been flooded? yes no don t know If yes, describe in more detail. b. How will the proposed lot(s) be drained? natural ditches storm sewer curb and gutter c. Is a new private drainage works proposed? yes no d. Do you have a water rights licence? yes no If yes, date issued: 8 Sewer and Water Supply Indicate in the table the type of sewage disposal and water supply that is existing for any current structures and proposed for the new lot(s) shown on the sketch attached to your subdivision application. Sewage Disposal Existing Lot(s) Proposed Lot(s) municipal sewer holding tank septic field ejector other (please specify) Water Supply Existing Lot(s) Proposed Lot(s) piped water shared well (indicate number of connections) individual well cistern other (please specify) 9 Utilities The Water Rights Act requires a person to obtain a valid licence to control water or construct, establish, or maintain any water control works. Water control works are defined as any dike, dam, drain, drainage, culvert, etc. that temporarily or permanently alters or may alter the flow or level of water. For details on water supplies, refer to the Planning Resource Guide: Subdivision in Manitoba available online. Electrical power is: existing proposed not required not available Natural gas is: existing proposed not required not available Telephone service is: existing proposed not required not available Utilities may still require an easement agreement for any existing facilities. 5

10 Access a. Current access (ex: driveway, lane) to the lot is by (and check all that apply): municipal road provincial road # provincial trunk highway # no access b. Will the lot(s) require a new driveway? yes no If yes, new access to the lot will be by: municipal road provincial road # provincial trunk highway # no access c. Will the driveway be shared? yes no d. Will a new public road be created? yes no Show existing and proposed driveways on the surveyor s subdivision application map. 11 Reason for Application and Other Comments Indicate the reason for making this application and provide any other information you think may be helpful. February 2019 6