Quarrying Permit Application

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Privacy Act Statement

The information you provide in this document is collected under the authority of the Territorial Quarrying Regulations for the purpose of applying for a quarrying permit. Information on individuals is used by Aboriginal Affairs and Northern Development Canada Mineral and Petroleum Resources Branch employees who need to know the information in order to respond to the program requirements. We do not share the personal information with other government departments. The personal information will be retained for 5 years after the last administrative use and then transferred to Library and Archives Canada. Individuals have the right to the protection of and access to their personal information under the Privacy Act  .



Applicant Name


Company Name
Address


Telephone Number
 

Facsimile Number


Cellular Number
Sub-Contractor or Pit Operator

____ Same as above

Name/Company
Address


Telephone Number
 

Facsimile Number


Cellular Number
I hereby apply for a Quarrying Permit for the purpose of taking:
Amount of Cubic Metres

  • Sand
  • Gravel
  • Stone
  • Loam
  • Other (please specify): ________
Amount of Cubic Metres

  • Sand
  • Gravel
  • Stone
  • Loam
  • Other (please specify): ________
Amount of Cubic Metres

  • Sand
  • Gravel
  • Stone
  • Loam
  • Other (please specify): ________
Location of Pit


NTS Map Sheet No.


Co-Ordinates
Land Use Permit
  • Existing

Land Use Permit No.
Expiry Date (YYYYMMDD)


  • New Application

Application Date: (YYYYMMDD)
Quarry Site
  • Existing
  • New
Application made to:
  • MVLWB 
  • WLWB 
  • SLWB 
  • GLWB 

1. A Quarry Operations Plan is required with this application and must be approved by a Land Use Inspector prior to approval and
issuance of the quarry permit if:

(A) The volume being applied for is greater than 1,000 m3 and/or
(B) The quarry site is being operated by multiple users

The Quarry Operations Plan includes the following mandatory information:

  • North Arrow
  • Map Scale at 1:5000
  • NTS Map Sheet or acceptable alternate at 1:50,000
  • Coordinates of quarry site - 4 corners (NE, NW, SE, SW)
  • Total area of the identified quarry resource
  • Area of existing clearing
  • Area of proposed quarrying
  • Topsoil/overburden storage area
  • Access roads/trails
  • Camp locations identifying all infrastructure to be established on the site
  • When applicable, blast pattern details must be indicated
  • Closure and Reclamation Plan including:
    • Camp reclamation, if applicable
    • Abandonment of active quarry face
    • Waste disposal
    • Stockpile removal
    • Road closure
    • Soil remediation for contaminated soils
Failure to submit an acceptable Quarry Operations plan (when required) will result in rejection of the Quarry Permit Application.
Complete 2 - 7 below only if a Quarry Operations Plan is not required.
2. Is any part of the land occupied? And if so, by whom and for what purpose?

 

 

3. The only buildings or other improvements on the said lands are as follows:
Nature of Improvements

 

 

Value of Improvements

 

 

Owner of Improvements

 

 

4. The land is/is not wooded.
  • No
  • Yes

If yes, describe species of trees and approximate size:

 

5. Please describe the proposed methods of brush and or timber disposal to be used on the site (if required).

 

 

6. If a camp is to be utilized please describe the proposed methods for:
Combustible Garbage

Non-combustible Garbage
Food Wastes

Grey Water
Black Water

Potable Water Supply
7. Please describe the proposed reclamation techniques that will be applied to the quarry site upon or prior to termination of the Quarry Permit:

 

 

 

I enclose the required fees as indicated below:

Total
$
Quarrying Permit Fee: ($150.00)

150.00
Royalties on sand, gravel, loam per cubic metre: ($1.50)

 
Royalties on other building materials per cubic metre: ($1.25)

 
Total Fees:

150.00
1. The attached plan is a sketch plan of the land as required by the Territorial Quarrying Regulations (Sketch should include an indication of the area to be worked).

___See Quarry Management Plan

2. Sketch Plan:

 

 

 

 

 

 

 

 

Use Additional sheets if required.
3. Co-ordinates of Site (Latitude and Longitude):

NW Point: _________

NE Point: _________

SW Point: _________

SE Point: _________

Signature of Applicant

Date (YYYYMMDD)

Note to Client: Alteration to base form will not be accepted.

For Internal Use Only

Reviewing Officer (Print Name)

Signature
Date Application Deemed Complete




Date Application Faxed





Sent to:
  • Yellowknife
  • Inuvik
  • Nunavut

INTER 50-017E 2012-04-01