LG 120

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Documents or information provided to Alberta Sustainable Resource Development pursuant to Section 15(1)(a) of the Water (Ministerial) Regulation are public records which are accessible by the public.

PURPOSE

Aquatic Vegetation Control
Erosion Protection
Reservoir Construction / Bank StabilizationBeach Construction Domestic Waterline
Outfall ConstructionPermanent Boat Launch Permanent Pier Site
Other

Applicant's Name and Address:

Print Name or Registered Company Name: / Home Telephone:
() / Bus. Telephone:
()
Address (Street, P.O. Box, etc.) / Place, Province: / Postal Code: / Fax:
()

Is the applicant the adjacent land owner? Yes No If no, PROVIDE written consent from the adjacent land owner.

Is the applicant a Canadian citizen? Yes No Has the applicant attained the age of 18 years? Yes No

Is the applicant an employee of the Government of Alberta or member of the Legislative Assembly?

No Yes Department.

Authorized Representative (if not the same as Applicant):

Print Name or Company Name: / Home Telephone:
() / Bus. Telephone:
()
Address (Street, P.O. Box, etc.) / Place, Province: / Postal Code: / Fax:
()
Location of Modification
¼ Sec. Twp. Rge. M / Name of Water Body if known / Name of Subdivision / Plan No. Block Lot Parcel / Proposed Date of Commencement and Completion

Information Requirements to Accompany Application Form:

(a)A plan of proposed activity as per attached sample plans and Content Requirements for Disposition Plans.

(b)A location plan must show:

(i)proposed works in relation to property lines

(ii)if applicable, any municipal reserve lands between the applicants property and the water body

(iii)location of proposed works and the present, highest, and lowest known water levels

(iv)if applicable, dimensions of the site (e.g. outer boundary of the area required to enclose the installation)

(v)minimum plan size 21.5 cm x 28 cm

(c)Cross sections must show:

(i)existing conditions and proposed modifications

(ii)relevant measurements

(iii)minimum plan size 21.5 cm x 28 cm

(d)A letter stating:

(i)what the proposal is

(ii)why it needs to be done

(e)If available, a photograph, or copy of a photograph showing the existing shore line

Note:A development permit may be required from the local authority where the proposed activity may involve the use of Municipal Reserve lands.

DateSignaturePrint NameTitle

Alberta Sustainable Resource Development Use Only
Authority under the Water Act / Authority under the Public Lands Act
Waiving notice of Application: / Land Administration
Notice of Decision:
Approval Issue Date:
File Number: / Client I.D. Number: / File Number:
Approval Number: