Provinec oi British Cotumbia

SCHEDULE B

APPLICATION UNDER SECTION 12 (1) OR 20 (1) OF PAL.C. FIO NO, entree

AGRICULTURAL LAND COMMISSION ACT
R.D./Mun, File No,

Receipt No.

INFORMATION TO BE SUPPLIED BY APPLICANT
(Please submit completed forms to the Regional District Office or if applicable, the Municipal Office.)

REGIONAL DISTRICT/MUNICIPALITY City of Port Coquitlam

PROPERTY CWNER'S NAME (Please Print) AUTHORIZEO AGENT OF THE COWNEA (Please Print)
Corporation of the City of Port Coquitlam Mr. BYR. Kirk, City Administrator
AODAESS OF OWNER . AODORESS OF AGENT

2272 McAllister Avenue
CITY/TOWN/VILLAGE CITY /TOWN/VILLAGE
Port Coquitlam, B.C. :
POSTAL CODE POSTAL CODE
V3C 2A8
TELEPHONE No. TELEPHONE No.
941~5411
“if agent is submitting the appi ization must be ted from the regi owner of the property.

Ful Legal Oceenonon of Each Exuung Land Tite Paro Linder Appacanon sporoumane Aree of Each

Lots 1-6 and 21-26, Block 3 ali of the Westerly Ptn. of DL 290,Grp. 1, Plan 1957 NW
Lots 1-6 and 7-12, Block 4 "

Lots 1-6 and 7-12, Block 5

Lots 1-5, and .25'°S 26, Block 9

Lots 1-6 and 7-12, Block 10

Lot A, Block 6,D.L. 290, Group One, Plan 13637

Lots 1-6 and 10-12, Block 11, DE 290, Group 1, Plan 1957 stp
Lots 13~20,Block 25 ptn.of D.L. 174 and 289, Grp. 1, Plan 2080, 3

TOTAL AREA IN HECTARES

! enclose a copy of one of the following for the Date on whic . property was purchased or. interest
property/properties under application: in property acquired by the applicant:

GI Certificate of Indefeasible Title, or ; Various

CO State of Title Certificate, or See Certificates attached.

0 Tax/Assessment Notice.

(Oey) UMorcy

| hereby make application under: -
(Please check aporopnate box)
C) (a) section 20 (1) of the Agricuitural Land Commission Act to
{i) subdivide the subject property, and (or)
(li) use the subject property for non-farm purposes within the ALR plan.

or -
Gd (b) section 12 (1) of the Agricultural Land Commission Act to have the above-described property excluded
from the Agricultural Land Reserve Plan.

In support of this application | submit a plan or plans of appropriate scale showing each of the following:
1. th subject property in terms of the smailest existing land tile parcet or parcels, dentlied by full legal Gascrption, and
showing the area of the land btle parcel of parcels, and dimensions of eacn OoUNcary incucing Ine udhacr land Ste
parcels;
2 the location of the subject property within the Agneuitural Land Reserve:
1. the location of any pennanent Cweilings of mooile homes and any existing Owidings ur structures on ine property;
4. the proposed new tand tite parce!s to be cmated on the sudiect property snowng acoroxmate areas of the rogosed
Garcels and aoproximata dimensions of each Coundary oF the propased locaton of any adaitional dwellings oF
buildings to ba constructed:
5, the location of properves. other than the subject proverty, which are under the ownersnic, lease or rental of Ine
applicant, In the vicinity of the suject property;
6. the location of waterways, roads and/or ngnts of way (Dubhe of pevale and surface condition), benches, ndges of omer
Segnificant topographical features and any areas uncer dusn, cleared, pasture, cultivated land, ete.
ia preferable, but not mandatory, that the pians be based On inose prepared by 4 professional surveyor, engineer, arctulect or planner. Such msos (nang been
Ghewn at some time in the past for another purpose) are often avavabie loan (a @ olan srints of
trom the land ote office for the coat . copying). The maps shoud ently individual parcels Gy legal ft
Sach of the sugject parcais.

AGR 2001 REV 84/7

Bo |
Moree erenry sav Une