Conservation Proposal Form

Extracted text (beginning)

OFFICE USE ONLY
File Number:
SECTION 3: DESCRIPTION OF PROPERTY
(AS INDICATED ON STATE OF TITLE CERTIFICATE)
Plan
District Lot/Section
Other Description
Lot/Parcel
Range
Street Address or General Location
(From Property Assessment/Tax Notice) 
(From State of Title Certificate)
SECTION 1: OWNER INFORMATION
(ADD ADDITIONAL PAGE IF MORE THAN TWO OWNERS)
First Owner Information
Second Owner Information
Name
Street Address
CityRegion
Postal/Zip Code 
Telephone
Cell
E-mail
Name
Region
Street Address 
City
Postal/Zip Code 
Telephone
Cell
E-mail
SECTION 2: APPLICANT INFORMATION 
(IF DIFFERENT FROM OWNER)
RegionCity
Postal/Zip Code
Telephone
CellE-mail
NameStreet Address
Conservation Proposal Form - Voluntary
Page 1 of 4
Suite 200 - 1627 Fort Street, Victoria, BC V8R 1H8
Telephone: 250.405.5186 
Fax: 250.405.5155
Email: itcmail@islandstrust.bc.ca
Conservation Proposal Form
Voluntary Conservation Covenant or Land Donation
hectares  
Voluntary Land DonationVoluntary Conservation Covenant
(Please Check 

 One Item to the right) 
-
Jurisdiction and Folio Number
Parcel Identifier (PID) 
-
Proposed Covenant or Land Donation Size
Block
  
Toll Free via Service BC in Vancouver 604.660.2421   Elsewhere in BC 1.800.663.7867
Website: https://islandstrust.bc.ca/conservancy/
April 7, 2022

 
SECTION 4: 
Please provide a detailed site plan, drawn to scale, indicating the area for conservation, notable natural 
features and any structures or property improvements (e.g. power lines, telephone lines, internet lines, septic field, 
septic tank, septic or sewage lines, wells, water lines, trails, driveways, roads, docks, seawalls, etc.).  If you anticipate 
needs for future property improvements or structures, please indicate where these may be placed.  The site plan may be 
done digitally or manually.  If being done manually, it should be done to scale on 11x17 paper.  If being provided digitally, 
please provide it as a .pdf and .jpg file at a scale suitable for printing on 11x17 paper.
land is not subdivided in the future, to maintain the general character of the site or area, provide for specific use, to 
buffer an existing protected area, etc.)
 
SECTION 5: 
Why do you want to covenant or donate your land? (e.g., to protect certain feature(s) on-site, to ensure 
SECTION 6: 
Please  provide a  description  of  special  featur
es  on  the  property (e.g., 
plants,  trees,  animals,  birds, 
geology, views, lakes, wetlands, etc.). Maps, sketches, photos, studies or reports can be attached to this proposal to 
further illustrate these features.
SECTION 7:  Please provide a description of any improvements on the land (buildings, structures, docks, trails, roads, driveways, etc.) and
Conservation Proposal Form - Page 2 of 4Voluntary
 indicate these on the site plan described in Section 4.
April 7, 2022

Is this property or a portion of the property in the Agricultural Land Reserve or Forest Land 
Reserve?
AGRICULTURAL LAND RESERVE
NO
YES
If yes, size of area:
hectares
PRIVA

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