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Development Permit Application Form
(office use only)
Development Permit File No.:
Date Application Received:
Tax Roll No.:
Development Permit Fee:
Date Fee Received:
Date Application Deemed Complete:
Date of Decision:
This project is:
New construction
Residential
Commercial
Industrial
Other
Addition to existing building
Change of use
Revisions to an approved DP
District:
IDP (if any):
Proposed Use(s) (as listed in the land use bylaw):
Permitted Use
Discretionary Use
Plans Attached:
Site Plan: YES or NO
Floor Plan: YES or NO
Fee information This fee information is provided for convenience only and is subject to change as per the
Fees and Charges Bylaw B464/25
RESIDENTIAL:
NON-RESIDENTIAL:
$0-$249,999 - $50 APPLICATION FEE
$0-$249,000 - $100 APPLICATION FEE
$250,000+ - $100 APPLICATION FEE
$250,000-$499,000 - $250 APPLICATION FEE
$500,000 - $999,000 - $500 APPLICATION FEE
$1 MILLION - $4,999,999 - $1000 APPLICATION FEE
$5 MILLION+ - $2,500 APPLICATION FEE
This application is to be completed in full by the registered owner of the land or by an authorized person acting
on behalf of the owner. Please meet with the Planning and Development Department prior to submitting your
application.
STATEMENT OF INTENT
I/We,
hereby make application to develop:
.
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APPLICANT INFORMATION
1)
Applicant:
Company:
Email Address:
Telephone:
Mailing Address:
Alternate Telephone:
Town:
Prov.:
Postal Code:
2)
Registered Owner:
(if applicant is other than owner)
Company:
Email Address:
Telephone:
Mailing Address:
Alternate Telephone:
Town:
Prov.:
Postal Code:
DEVELOPMENT INFORMATION
3)
Rural Address:
Legal Description:
Plan:
Block:
Lot:
4)
Detail the proposed use(s) of the building/site:
Detail all proposed new buildings or structures on site:
Building Site:
Length (ft/m):
Building Site:
Width (ft/m)
Building Site:
Height (grade to peak) (ft/m):
Building Site:
Sq. foot (ft/m)
Water Supply:
Sewer Supply:
Proposed setbacks from the property line:
Front Yard (ft/m):
Rear Yard (ft/m):
Side Yard 1 (ft/m):
Side Yard 2 (ft/m):
Setbacks From:
Top of Bank (ft/m):
House/shop/other (ft/m):
Water body (ft/m):
Estimated Project Commencement Date:
Estimated Project Completion Date:
Construction Costs:
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RIGHT OF ENTRY
I/We,
give consent to allow a person(s) designated by Northern
Sunrise County the right to enter and inspect the above land and/or building(s) with respect to this
application only.
Signature:
Date:
ABANDONED WELL DECLARATION
Subject to the Alberta Energy Regulator Directive 079 the applicant is required to obtain confirmation of the exact
location of any abandoned well and required setbacks from well from the Well Licensee. Please confirm the exact
location of any abandoned well and required setbacks from well.
https://geodiscover.alberta.ca/GDA/Viewer/?Viewer=GDA.
6)
Abandoned well is:
Present
Absent
Signature of Applicant
Date
If an abandoned well is present, please complete the declaration.
I/We, have reviewed information provided by the Energy Resources Conservation
Board ("ERCB") as set out in ERCB Directive 079, Surface Development in Proximity to Abandoned Wells, and
can advise that the licensee(s) responsible for all abandoned wells within the site of proposed development has
been contacted in order to have the Abandoned Well Locating and Testing Protocol completed in accordance
with ERCB Directive 079. To prevent damage to the well, a temporary identification marker will be placed on
abandoned wells prior to construction, according to the confirmed well location(s) on site. The site of proposed
development contains the following abandoned well(s):
ERCB Well
License #
Licensee name
Licensed Surface
Location
Contact Personnel
Name
Phone number
CERTIFICATION AND SIGNATURE
Registered owner or person acting on their behalf
I, hereby certify that I a) am the registered owner or b) am authorized to act on behalf of the registered
owner(s), and that the information given on the form is complete and is, to the best of my knowledge, a true
statement of the facts relating to this application.
7)
Applicant's Signature:
Date:
Landowner's Signature:
Date:
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SCHEDULE "A"
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Plot Plan
Note: Indicate the location of the Development and/or Subdivision on the quarter of land.
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SCHEDULE "A"
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Plot Plan
Note: Draw a detailed map of the development area highlighting the following:
Provide the closest distance of proposed development(s) from:
1. All property lines
2. All roads and approaches
3. Top of the bank (if it is within 200 feet of the proposed development) from all water bodies and watercourses
4. All existing and proposed buildings
Note: Top of the bank is considered the point of first drop from the plain where the development is proposed
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Page 7 of 8
o
o
o
o
ADDITIONAL APPLICATION REQUIREMENTS
The Development Permit Application must be completed prior to a decision being made. Below is a
generalized list of requirements. The Development Officer may require additional information per Land Use
Bylaw B458/24 depending on the specific nature of the application. Please meet with the Planning and
Development Department prior to submitting your application, to review the required information.
The application must include the following:
OFFICE
COMPLETED BY APPLICANT
Y/N
Application fee -The fee must be paid in full at the time of application.
Y/N
Rural Addressing Application - Additional form to complete if the development is the first
dwelling in any district other than hamlet residential.
Y/N
Y/N
Geotechnical Assessment - If the development application is within the top of bank setbacks
identified by the land use bylaw, a geotechnical assessment must be prepared by a qualified
professional Geotechnical Engineer licensed to practice in Alberta.
I have read and understand the recommendations included in the 2013 Thurber Report
Initials
Y/N
Manufactured Home - Floor plans that must include:
1) roof pitch
2) eaves
3) width to length ratio
4) pictures of siding/proposed skirting
Y/N
Y/N
Moved In Buildings - What year was the building constructed __________.
Applications for the Moved In Building shall include:
1) Coloured photographs of the building
2) Statement regarding the present location of the building
3) Notification of the relocation route
4) A complete site plan showing all buildings and located or to be located on the property.
Y/N
Roadside Development Permit from Transportation and Economic Corridors:
If the development is within 300 meters of a provincial highway (Highways 2, 688, 986, 88, 750,
744 & 683) right of way boundary, or within 800 meters of the center point of an intersection of
the highway with another public road, a roadside development permit is required from
Transportation and Economic Corridors.
PLEASE NOTE THAT THIS IS AN APPLICATION FORM ONLY AND DOES NOT AUTHORIZE THE
COMMENCEMENT OF DEVELOPMENT OR USE OF A BUILDING OR LAND. A SEPARATE DECISION
NOTICE WILL BE ISSUED ONCE YOUR APPLICATION HAS BEEN PROCESSED. PLEASE ALLOW 40
(FORTY) DAYS FOR THE PROCESSING AND ISSUANCE OF A DECISION ON YOUR APPLICATION.
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NOTICE TO APPLICANT
To assist you in the successful completion of your project, depending upon the type of development you are
doing, we suggest that prior to starting your development you contact the following:
1) An Accredited Agency Authorized by Alberta Municipal Affairs to issue permits pursuant to the Safety
Codes Act of Alberta in the disciplines of Building, Electrical, Fire, Gas, and Plumbing as follows:
2) To determine whether specialized health regulations pertain to your development (i.e. work camp) contact:
Alberta Health Services (Peace River Office)
PO Box 6178
Peace River AB T8S 1S2
Telephone: (780) 624-7260
3) If development is within 300 meters of a provincial highway (i.e. Highways 2, 688, 986, 88, 750, 744, and
683) right-of-way boundary or within 800 meters of the center point of an intersection of the highway with
another public road a roadside development permit is required from:
Transportation and Economic Corridors
Bag 900 - 29
Peace River AB T8S 1T4
Telephone: (780) 624-6280
prior to obtaining a development permit from Northern Sunrise County.
4) Water applications for Hamlet and Regional line customers are available at Northern Sunrise County office.
5) This Development Permit does not guarantee, imply, or suggest that Northern Sunrise County or
Transportation and Economic Corridors will undertake any road improvements at or near the subject
property to improve the applicant's accessibility to his or her property.
6) With your co-operation and the assistance of these Government Departments, we feel that any potential
difficulties will be dealt with before actual construction of your development begins.
Agency Name
Phone
Fax
Bldg
Permit
Elec.
Permit
Gas
Permit
Plumbing
Permit
Superior Safety Codes Inc.
(780) 489-4777
1(866) 999-4777
(780) 489-4711
1(866) 900-4711
Yes
Yes
Yes
Yes
The Inspections Group Inc.
(780) 454-5048
1(866) 554-5048
(780) 454-5222
1(866) 454-5222
Yes
Yes
Yes
Yes