Application to Access Gwich'in Private Lands

Application To Access Gwich’in Private Lands
Type of Application
Application #:
Company/Application Name:
Company Registration #:
Phone Number
Format: (000) 000-0000.
Mobile
Format: (000) 000-0000.
Fax
Format: (000) 000-0000.
Address:

Address Line 1

Address Line 2 or P.O Box

CityState / Province

Postal / Zip CodeCountry
Email
example@example.com
Have you been in contact with the following? (enter date of contact below)ov
Gwich’in Land and Water Board

MonthDayYear
Date
Gwichya Gwich’in Council (Tsiigehtchic)

MonthDayYear
Date
Gwich’in Land Use Planning Board

MonthDayYear
Date
Ehdiitat Gwich’in Council (Aklavik)

MonthDayYear
Date
Gwich’in Renewable Resource Board

MonthDayYear
Date
Nihtat Gwich’in Council (Inuvik)

MonthDayYear
Date
Department of Culture and Heritage

MonthDayYear
Date
Tetlit Gwich’in Council (Fort McPherson)

MonthDayYear
Date
Purpose of application:
Description of operation type of undertaking proposed: (check the following). Please Note: There might be fees associated with the type of operation. Please refer to GLR Fee Schedule found here: https://www.gwichintribal.ca/forms.html

Other

Period of operation (include all phases of project, work applied for, including restoration).

Rows	Gwich’in Settlement Lands Parcel #	Latitude	Longitude
1
2
3
4
5

Upload file(s) with location data - Max 100mb (pdf, xls, xlsx, csv, kmz, kml, zip) - Zip Multiple Files

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Describe access to site (be specific, indicating use of new or existing routes and if the access has been ground truthed):
Provide a description of any camp(s) (if applicable):
Describe your disposal method for garbage, sewage, trees, bush and overburden:
Water use (list and describe all required uses of water during the activity, estimated volume and the location of the source):
During the proposed activity, will you be required to do any of the following?
Describe how you propose to conduct the above-listed activities:
List equipment for all activities and their proposed use (including drills and pumps, etc.)
List all fuels and other hazardous materials and method of storage used:
Containment and spill contingency plans
Calculations of area involved (include access, staging area, airstrips, camp sites, etc.):
List of other contractors:
List of personnel:
Environment and/or resource impacts and proposed mitigation for all disturbances and impacts:
Identify any monitoring programs:
Restoration plans and proposed restoration for all disturbances and impacts:
Authorized Representaive
Applicant (Print Full Name)
Date

MonthDayYear
Date
Signature
Date

MonthDayYear
Date
Gwich'in Tribal Council (for GLR use only)
Accepted By
Date

MonthDayYear
Date
Remarks
Application Fee
Date Received

MonthDayYear
Date
Please verify that you are human
Should be Empty:

Application To Access Gwich’in Private Lands