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COLUMBIA SHUSWAP REGIONAL DISTRICT (Camosun College)

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COLUMBIA SHUSWAP REGIONAL DISTRICT
555 Harbourfront Drive NE, PO Box 978, Salmon Arm, BC V1E 4P1
T: 250.832.8194 | F: 250.832.3375 | TF: 1.888.248.2773 | E: plan@csrd.bc.ca |www.csrd.bc.ca
CSRD Development Application Form Last Updated: January 2021 Page 1 of 7
DEVELOPMENT APPLICATION FORM
Applicants are advised to consult with Development Services staff before submitting a Development Application to the CSRD. Fees are non-
refundable unless otherwise noted.
IMPORTANT: An application is considered incomplete and pending until all required documentation
is received; applications are only placed in the queue for processing once all required documentation is received.
Application Type (check all that apply). Fees outlined in Development Services Application Fees Bylaw No. 4000.
*Sign Notification Requirements: Certain applications require that a sign be posted on the property to advise the community of the proposed
development, and invite comments and questions. Staff will advise if a sign is required as part of your application process.
**Please check off both the application type(s) and 'after the fact' application if development and/or Bylaw Enforcement has begun.
Owner Information (Registered owner(s) information required).
☐
Additional page(s) attached.
Full Name(s):
Mailing Address (house number, street name, city, province, postal code):
Phone:
Cell Phone:
E-mail:
Preferred method: ☐ Phone ☐ Email
Applicant Information
(If the applicant is not the owner(s) or if one registered owner is assigned to act as agent on behalf of all registered
owners, complete this and the agent authorization section).
Full Name:
Mailing Address (house number, street name, city, province, postal code):
Phone:
Cell Phone:
E-mail:
Preferred method:
☐
Phone
☐
Email
NOTE: In order to use an agent to work on the owners' behalf, all registered owners on title must sign to grant authorization. If the property is owned by a
corporation, a designated person with signing authority for the company must sign the form and provide documentation of signing authority. Attach a separate
page with additional signatures if necessary.
Authorization of Agent
(Complete only if the applicant is not the owner(s) or if one registered owner is assigned to act as agent on behalf of
all registered owners). ☐ Additional page(s) attached.
As owner(s) of the land described in this application, I/we hereby authorize ______________________________ to act as agent in regard
to this land development application and understand that the Agent will be the point of contact with the CSRD.
Print name of Owner
Signature of Owner
Date (mm/dd/yy)
Print name of Owner
Signature of Owner
Date (mm/dd/yy)
☐ Flooding/Debris
☐
Lakes 100m
☐
Steep Slopes
☐
Riparian Area
☐
Foreshore/Water
☐
Form/Character
☐
☐ Development Permit Amendment
☐ Floodplain Exemption
☐ Development Variance Permit
☐ Temporary Use Permit*
☐ Temporary Use Permit Renewal*
☐ Board of Variance
☐ Land Use Bylaw Amendment*
☐ Zoning Bylaw Amendment *
☐ Official Community Plan (OCP) Amendment*
☐ OCP and Zoning Bylaw Amendment *
☐ Comprehensive Development Amendment*
☐ 'After the fact' application**
CSRD Development Application Form Last Updated: January 2021 Page 2 of 7
Property Information (Complete all property information of land under application, if available).
Legal Description (lot, block, section, township, range, district lot, land district, plan):
Civic Address (house number, street name, city, province, postal code):
Parcel Identifier (PID):
Size of property (hectares or acres):
Existing Land Use (i.e. How is the land used? What buildings and structures are on the property? What are they used for?)
Proposed Use / Description of Proposed Development and / or Proposed Variances (Please attach separate pages if
necessary).
☐
Additional page(s) attached.
Click here to enter text.
Declaration (If no agent has been authorized as the applicant, all registered owners must sign declaration. If more than two individual owners,
attach a separate page with additional signatures).
☐
Additional page(s) attached.
I, the undersigned, hereby certify that the attached information, provided with respect to this application is full and complete and a true
statement of facts, and hereby agree to submit further information as may be deemed necessary for processing the application.
Further,
I consent to authorizing the CSRD to include and publicly disclose personal information, which does not include contact information, as
defined in the Freedom of Information and Protection of Privacy Act of BC, in staff reports, meeting agendas, application file names,
bylaws, and permits related to this application.
Print name of Owner/ Agent
Signature of Owner/ Agent
Date (mm/dd/yy)
Print name of Owner/ Agent
Signature of Owner/ Agent
Date (mm/dd/yy)
CSRD Development Application Form Last Updated: January 2021 Page 3 of 7
DEVELOPMENT APPLICATION CHECKLIST
IMPORTANT: An application is considered incomplete and pending until all required documentation is received; applications are only
placed in the queue for processing once all required documentation is received.
Development Permit, Development Variance Permit, Temporary Use Permit, Bylaw Amendment, Flood Plain Exemption, Board of
Variance.
Checklist:
☐ Completed application form
☐ Fee paid: As set out in CSRD Development Services Application Fees Bylaw No. 4000
• Application fee
• Land Title Office registration (only applicable for Development Permits and Development Variance Permits)
☐ Certificate of Title or Title Search - dated within the last 30 days. Obtained through BC Land Title & Survey
☐ All documents listed on title (e.g. covenants and easements)
☐ Development Approval Information Assessments (i.e. Preliminary Project Impact Assessment – pages 5, , FireSmart
Assessment – pages 6-7 ). Applicable for Development Permit (not Foreshore/Water), Rezoning, and
Temporary Use Permit applications. As set out in CSRD Development Approval Information Bylaw No. 644
☐ Professional report(s) if applicable
☐ Site plan showing: (preferably in metric. Sample site plan on page 4)
• North arrow;
• Dimensions and boundaries of property lines, rights-of-way, and easements;
• Location and dimensions of all existing and proposed buildings and structures, and the setbacks (including
projections and overhangs) to parcel lines, rights-of-ways, easements;
• Location of existing access roads, driveways, vehicle parking spaces, pathways, screening and fencing;
• Material driveway is made of (asphalt, gravel, etc.)
• Location of any physical or topographical constraints (such as watercourses, shorelines, ravines, wetlands, steep
slopes, bedrock outcrops, etc.);
• Location of all existing water lines, wells, septic fields, including sizes; and
• Existing covenant areas (if applicable).
Staff may request a surveyed site plan by a BC Land Surveyor to confirm setbacks and/or building locations
☐ Completed Provincial Site Disclosure Statement
. Applicable for Development Permit (not Foreshore/Water) and
Rezoning applications. Statement Form and Schedule 2 Specified Industrial or Commercial Uses attached to paper copies
or
pdf fillable form here.
CSRD Development Application Form Last Updated: January 2021 Page 4 of 7
SAMPLE SITE PLAN
CSRD Development Application Form Last Updated: January 2021 Page 5 of 7
PRELIMINARY PROJECT IMPACT ASSESSMENT
This preliminary assessment is required to assist the Development Services Department in assessing applications for potential
community and site impact. You may be requested to supply more formal and complete information concerning the impact of your
proposal before your application can be processed.
CHECKLIST YES NO
1. Does the project have multiple phases? If yes, please attach the description of the phases and timeframes
on a separate page.
2. Does your property contain or have a boundary with a watercourse?
3. Does the project involve works within 30 m (98.4 ft) of any watercourse?
4. Does the project involve works within 100 m (328.1 ft) of a Lake?
5. Does the project involve works on slopes of 30% or greater?
6. Does the development have the potential to increase the need for public services or infrastructure, such as
schools, roads, fire protection, solid waste facilities, transportation, hospitals, parks, etc.?
7. Will your proposal require an amendment or variance of a CSRD bylaw or Plan? If yes, please attach the
description on a separate page.
8. Will the proposed use cause any public nuisance such as noise, odours, light/glare or dust?
9. Are there any restrictive covenants on the proposed site?
10. Will the proposal generate appreciable additional vehicular traffic, have a substantial effect on existing
transportation systems, increase parking demands, or increase hazards for pedestrians or cyclists?
11. Is substantial creation, upgrading or extension of utilities (sewer, water, storm drainage, etc.) required?
12. Will the proposal impact upon parks, natural areas, beaches and waterfront access, or outdoor activities?
13. Does the proposal have any potential to alter an archaeological site?
14. Will any excavation, removal or addition of soil (including gravel) be required within a development permit
area?
15. To your knowledge, have any industrial or commercial uses occurred on the property which may have
contributed to site contamination? If yes, please complete the Site Profile forms.
16. Does the project involve any works on the foreshore or water structures, such as docks, buoys, marinas,
etc.?
17. Will the proposal be accompanied by any professional studies, reports, plans, etc.? If so, please provide a
list that includes the professional designations of all persons involved.
18. Are there any other major impacts you foresee your project having on the site and/or community?
19. Does the project involve the removal, alteration, disruption, or destruction of vegetation involving more
than 30% of the parcel?
20. Have you completed and attached Schedule 'C' FireSmart Assessment?
21. Is your FireSmart Assessment score "High" (30-35 points) or "Extreme" (>35 points)?
CSRD Development Application Form Last Updated: January 2021 Page 6 of 7
FIRESMART ASSESSMENT
FireSmart Assessment Characteristics of Material
Point
Rating
Your
Score
What kind of roofing material do you have?
Asphalt shingles, metal, clay tile or ULC rated shakes 0
Unrated wooden shakes 30
How clean is your roof?
No needles, leaves or other combustible materials 0
A scattering of needles and leaves 2
Clogged gutters and extensive leaf litter 3
What is the exterior of your home built of?
Non-combustible material stucco, metal siding, brick 0
Logs or heavy timbers 1
Wood, vinyl siding or wood shakes 6
Are your eaves and vents closed up and screened?
Closed eaves and vents with 3 mm wire mesh 0
Closed eaves and vents with no mesh 1
Open eaves, open vents 6
Have you screened in your balcony, deck or porch? All decks, balconies and porches are screened or
sheathed in with fire resistant material
0
All decks, balconies and porches are screened or
sheathed with combustible material
2
Decks, balconies and porches are not screened or
sheathed in
6
How fire resistant are your windows and doors?
Tempered glass in all doors/windows 0
Double pane glass:
• small/Medium
• large
1
2
Single pane glass:
• small/Medium
• large
2
4
Where is your woodpile located?
More than 10 m from any building 0
Less than 10 m from any building 6
Is your home set back from the edge of a slope? Building is located on the bottom or lower portion of a
hill
0
Building located on the mid to upper portion or crest of
a hill
6
CSRD Development Application Form Last Updated: January 2021 Page 7 of 7
What type of forest surrounds your home, and how far
away is it?
Deciduous trees (poplar, birch) within 10 m of buildings
0
Deciduous trees 10 – 30 m from buildings
0
Mixed wood (poplar, birch, spruce, or pine) within 10 m
of the buildings
30
Mixed wood 10 – 30 m from buildings
10
Conifers (spruce, pine or fir) within 10 m of buildings
• separated
• continuous
30
30
Conifers (spruce, pine, or fir) within 10 – 30 m of
buildings
• separated
• continuous
10
30
What kind of vegetation grows in the zone around your
buildings?
Well watered lawn or non-combustible landscaping
material
0
Uncut wild grass or shrubs
• within 10 m of buildings
• within 10 – 30 m of buildings
30
5
Dead and down woody material within 10 m of
buildings
• scattered
• abundant
30
30
Dead and down woody material within 10 – 30 m of
buildings
• scattered
•
abundant
5
30
Are there abundant underbrush and ladder fuels in the
surrounding forest?
None within 10 – 30 m 0
Scattered
• within 10 – 30 m of buildings
5
Abundant
• within 10 – 30 m of buildings
10
The Wildfire Hazard Level for your home is :
Total
Score
Low < 21 points Moderate 21 - 29 points High 30 - 35 points
Extreme >35 points
The checklist above is from the BC Edition of the Home Owners FireSmart Manual.
FireSmart is a registered trademark of Partners in Protection Association.
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Completed 23 November 2021

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