Planning Application Authorization Form

Extracted text (beginning)

www.islandstrust.bc.ca 
 
 
Galiano, Mayne, North Pender,  
Saturna, South Pender Islands 
 
Victoria Office 
200 - 1627 Fort Street 
Victoria, BC  V8R 1H8 
Ph: (250) 405-5151 
southinfo@islandstrust.bc.ca 
Salt Spring Island, Ballenas-
Winchelsea Islands 
 
Salt Spring Office 
4 - 121 McPhillips Avenue 
Salt Spring Island, BC  V8K 2T6 
Ph: (250) 537-9144 
ssiinfo@islandstrust.bc.ca 
Denman, Gabriola, Gambier, 
Hornby, Lasqueti, Thetis 
 
Northern Office 
700 North Road 
Gabriola Island, BC  V0R 1X3 
Ph: (250) 247-2063 
northinfo@islandstrust.bc.ca 
 
Freedom of Information 
The collection of personal information, for the purpose of processing this application, is authorized under the Local Government Act, Community Charter and section 26(c) of the 
Freedom of Information and Protection and Privacy Act.  Enquiries may be directed to a Deputy Secretary at any of the Islands Trust Offices, as noted on page 1 of this form. A 
request for information, under the Freedom of Information and Protection of Privacy Act may be made to: FOI Coordinator, Islands Trust, 200-1627 Fort Street, Victoria, BC V8R 1H8, 
Tel. (250) 405-5151 foi@islandstrust.bc.ca 
Planning Application Authorization Form 
 
Applicant: 
Name Company 
  
Mailing Address 
 
 
Phone  Email 
  
Declaration: 
As the owner or agent authorized to act on behalf of the owner(s) of 
the subject property, I declare the information submitted in support 
of this application is true and correct in all respects. 
 
 
Signature 
Owner Authorization:  
 
As the  registered  owner(s) of  the  subject  property,  I/we declare  that  the  information  submitted  in  support  of  this  application  is  true  and 
correct in all respects. I/we hereby authorize Islands Trust staff or their contractors to conduct site inspections of the subject property for 
the purpose of processing this application, and hereby authorize and appoint: 
 
Print Name (Complete if applicant is not the owner(s)) 
 
... to serve as the agent for this application, and communicate with Islands Trust staff and Islands Trust bodies on our behalf.   
 
All registered owners on title must be listed on and sign the application. Corporations must include a list of directors.  
 
Name/Company Name Signature 
  
Mailing Address 
 
 
Phone  Print Name 
  
Email Date 
  
 
Name/Company Name Signature 
  
Mailing Address 
 
 
Phone  Print Name 
  
Email Date 
  

 
Name/Company Name Signature 
  
Mailing Address 
 
 
Phone  Print Name 
  
Email Date 
  
 
Name/Company Name Signature 
  
Mailing Address 
 
 
Phone  Print Name 
  
Email Date

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