Application to Access Gwich'in Private Lands

Application To Access Gwich’in Private Lands
Type of Application*

New ApplicationAmended Application
Application #:
Company/Application Name:*
Company Registration #:
Phone Number*
Mobile
Fax
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 BoardGwichya Gwich’in Council (Tsiigehtchic)Gwich’in Land Use Planning BoardEhdiitat Gwich’in Council (Aklavik)Gwich’in Renewable Resource BoardNihtat Gwich’in Council (Inuvik)Gwich’in Social and Cultural InstituteTetlit Gwich’in Council (Fort McPherson)
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*

TransportationQuarryIndustrialRecreationPower FacilityForestryOil / GasMining/Milling AgricultureResearchOther

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

	Activity	Earliest Start date	Latest Start Date	Earliest Finish Date	Latest Finish Date
1
2
3
4
5
6
7
8
9
10

Describe the operation (as much detail as possible).*
Location of activity (describe):*

	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?

Cross a watercourseControl floodingAlter the flow or store waterModify bed or bank of water courseDivert water
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*

Clear
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