Regional District of Kitimat-Stikine

Apply for a Temporary Second Dwelling Permit

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APPLY FOR A TEMPORARY SECOND DWELLING PERMIT

* Required Field

1. PROPERTY

Civic Address:

Legal Description:

* PID No:

Folio No:

* Is the Property subject to:ALRFarm Classification

2. PROPERTY OWNER / APPLICANT:

* Registered Owner(s):

* Street Address:

* City:

* Province:

* Postal Code:

* Home Phone:

Other Phone:

Applicant (if different from above):

Home Phone:

Other Phone:

Occupant of Second Dwelling:

Home Phone:

Other Phone:

3. DWELLING

* Description of Temporary Dwelling:

* Reason for Occupancy: Me (explain)Farm EmployeeDirect Family Member (Family Relationship)

Other (explain):

Expected Term of Occupancy:

Site Inspection Required:Yes No

Notice of Collection of Personal Information:

The information collected on this form will be used to process the application and for the purposes of administration and enforcement. The personal information is collected under the authority of the Local Government Act and the bylaws of the Regional District of Kitimat-Stikine. Information submitted may be made available for public inspection pursuant to the Freedom of Information and Protection of Privacy Act. Contact the Regional District of Kitimat-Stikine if you have any questions regarding the use of this information.

* By checking this box, printing my name and submitting this form, I confirm that the information provided is accurate and complete.

Print Name:

Date:

Security Measure