Development Related Conservation Proposal Form

Extracted text (beginning)

SECTION 3: DESCRIPTION OF PROPERTY 
(AS INDICATED ON STATE OF TITLE CERTIFICATE)
Plan
District Lot/Section
Block
Other Description
(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
City
Region
Postal/Zip Code 
Telephone
Cell
E-mail
Name
Region
City
Postal/Zip Code 
Telephone 
Cell
E-mail
RegionCity
Postal/Zip Code
CellE-mail
Name
SECTION 2: APPLICANT INFORMATION
(IF DIFFERENT FROM OWNER)
Conservation Proposal Form - Development
Page 1 of 4
 
Conservation Proposal Form
 Conservation Covenant or Land Transfer Connected to a Development A
 
pplication
 
OFFICE USE ONLY
File Number:
(Please Check 

 One Item to the right) 
 Conservation Covenant 
(Development Related)
Telephone
Lot/Parcel
Range
Street Address or General Location
Land Transfer
(Development Related)
Street Address
Jurisdiction and Folio Number 
Parcel Identifier (PID) 
Proposed Covenant or Land Donation Size
Street Address
hectares
 
 
 
April 7, 2022
Suite 200 - 1627 Fort Street, Victoria, BC V8R 1H8
Telephone:
 250.405.5186
Fax: 250.405.5155
Toll Free via Service BC in Vancouver 604.660.2421   Elsewhere in BC 1.800.663.7867
Website:
 https://islandstrust.bc.ca/conservancy/
Email: itcmail@islandstrust.bc.ca

 
SECTION 4: 
Please summarize your development application and indicate what is required (i.e., conservation
  c
covenant or land transfer).
SECTION 5: 
Please provide a description of special features on the property (e.g., plants, trees, animals, birds,
SECTION 6:
Conservation Proposal Form - DevelopmentPage 2 of 4
geology, views, lakes, wetlands, etc.).  Maps, sketches, photos, studies or reports can be attached to this proposal 
to further illustrate these features.
Please Note: The Islands Trust Conservancy board will only consider proposals for which there is a recent (within 
one [1] year of the submission of the development proposal) ecological assessment by a qualified ecologist/
biologist and archaeological review of both the covenant/land transfer areas and the proposed development. 
For covenants or land transfers that are the result of a density bonus program or amenities rezoning application, 
this assessment is required for both the density receiving or down-zoned area and the density sending or up-
zoned areas.
Please provide a description and a sketch map of the location of the proposed covenant or land donation and 
any improvements on the area (e.g., buildings, structures, docks, trails, roads, driveways, septic fields, wells, utility 
lines, water lines, etc.).
April 7, 2022

Is this property or a portion of the property in the Agricultural Land Reserve or Private Managed Forest Land 
AGRICULTURAL LAND RESERVE
NO
YES
If yes, size of area:
hectares
PRIVATE MANAGED FOREST LAND
NO
YES
If yes, size of area:
hectares
Name of the Organization/Conservancy
YES
NO
Note  that  such  an  organization/conser

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