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Subdivision ApplicationDate of Receipt:Accepted by: Fee Submitted:File Number: Registered Owner of Lands: _____________________________________________________________ Postal Code: _______________________ Email:______________________________ Postal Code: ________________________ Email:______________________________ Name of Surveyor: _____________________________________________________________________ Postal Code: ________________________ Email:______________________________ a. b. c. d. e. f. a.Is the land situated within the County of Newell? ☐ Yes ☐ No b.Is the land adjacent to a municipal boundary? ☐ Yes ☐ No c.Is the land within 1.6 kilometers (1 mile) of a highway? d.Does the proposed parcel contain or is it adjacent to a river, stream, lake or other body of water, or by a drainage ditch or canal? e.☐ Yes ☐ No f.Is there a Confined Feed Operation on the land or within 1.6 kilometers (1 mile) of the land being subdivided? a. b. c. 3. LOCATION OF LAND TO BE SUBDIVIDED If yes, the adjoining municipality is: ________________________________________________________ ☐ Yes ☐ No ☐ Yes ☐ No 4. EXISTING AND PROPOSED USE OF LAND TO BE SUBDIVIDED Existing use of the land: ________________________________________________________________ If yes, state its name: __________________________________________________________________ If yes, the highway number is: ___________________________________________________________ Total area of existing parcel of land is: _____________ Hectares _____________ Acres Being all/part of Lot/Unit ____________ Block ____________ Plan ______________________________ Size of lot(s): ___________________________________ Rural Address (if applicable): ____________________________________________________________ Certificate of Title No.(s): _______________________________________________________________ Total number of lots to be created: __________ Name of Agent (Person Authorized to act on behalf of Registered Owner): ____________________________________ 1. CONTACT INFORMATION All/Part of the _____ Quarter _____ Section _____ Township _____ Range _____W4M (e.g. NE 5-19-14W4M) 2. LEGAL DESCRIPTION OF LAND TO BE SUBDIVIDED Mailing Address: ______________________________________ Mailing Address: _____________________________________ Mailing Address: _____________________________________ Phone: ___________________Cell: ______________________ Phone: ___________________Cell: ______________________ FOR OFFICE USE ONLY Phone: ___________________Cell: ______________________ Is the proposed parcel within 1.5 kilometers (0.93 miles) of a sour gas facility? Proposed use of the land: _______________________________________________________________ Designated use of the land as classified under the Land Use Bylaw: _____________________________ ☐ Yes ☐ No APPLICATION FOR SUBDIVISION a. b. ____________________________________________________________________________________ c.Describe the kind of soil on the land (sandy, loam, clay, etc.): ___________________________________ d.Are there any active oil or gas wells or pipelines on the land?☐ Yes ☐ No e.Are there any abandoned oil or gas wells or pipelines on the land?☐ Yes ☐ No a.Is this a vacant parcel (void of any structures or buildings)?☐ Yes ☐ No ____________________________________________________________________________________ a. b. c. d. Signature of Registered Owner(s) and that information given on this form is full and complete and is, to the best of my knowledge, a true If "no", any building and any structures on the land: _________________________________________ 6. EXISTING BUILDINGS ON THE LAND TO BE SUBDIVIDED ☐ I am the registered owner, or☐ I am authorized to act on behalf of the registered owner 7. WATER AND SEWER SERVICES I _________________________________________________________________ hereby certify that 8. REGISTERED OWNER OR PERSON ACTING ON THEIR BEHALF _________________________ _____________________________ ________________________ statement of the facts relating to this application for subdivision. Signed: __________________________________Date: __________________________ of the County of Newell to enter my land for the purpose of conducting a site inspection and evaluation in connection with my application for subdivision. This right is granted pursuant to Section 653(2) of the Municipal Government Act. 9. RIGHT OF ENTRY I, ______________________________ ☐ do / ☐ do not (please check one) authorize representatives Describe the proposed sewage disposal: ___________________________________________________ 5. PHYSICAL CHARACTERISTICS OF LAND TO BE SUBDIVIDED Describe nature of the topography of the land (flat, rolling, steep, mixed): _________________________ Describe nature of the vegetation and water on the land (brush, shrubs, tree stands, sloughs, creeks etc. Describe existing source of potable water: __________________________________________________ Describe the proposed source of potable water: _____________________________________________ Year installed: ___________Describe the existing sewage disposal: _____________________________