FOR INTERNAL USE
Project Number:
File Number:
Disposition Number:
Client Number:
PACIFIC FRESHWATER/LAND-BASED
AQUACULTURE APPLICATION
MINISTRY OF FORESTS, LANDS AND NATURAL RESOURCE OPERATIONS
FISHERIES AND OCEANS CANADA
TRANSPORT CANADA
Please refer to Guide to the Pacific Freshwater/Land-based Aquaculture Application for
additional important information on how to complete this application correctly.
Incomplete applications will be returned to the applicant
PART I – GENERAL APPLICANT INFORMATION
SECTION A: APPLICANT AND GENERAL INFORMATION
1. Applicant Name(s) (Full Legal Name(s) or Registered Company Name):
Applicant Business Information:
Telephone: (
)
Cell: (
)
Fax: (
)
Email:
2. Applicant Business Mailing Address:
Postal Code:
3. Doing Business As:
4. BC Inc. #, BC Registration # or BC Society #
5. Physical Business Address (if different from above):
Postal Code:
6. Contact Name (if different from above):
Contact Business Information:
Telephone: (
)
Cell: (
)
Fax: (
)
Email:
7. Agent/Representative (if applicable):
Agent/Representative Business Information:
Telephone: (
)
Cell: (
)
Fax: (
)
Email:
Letter of Authorization Enclosed:
 Yes  No
8. Business Mailing Address of Agent/Representative:
Postal Code:
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 1 of 15
9. Type of Application:
TENURE TYPE: (please check only 1 box)  Licence of Occupation  Lease  Investigative Permit
 New Site
AMENDMENT TYPE: (please check all the boxes that apply)
 Amendment
 Tenure Area
 Infrastructure
 Production
 Species
 Other (describe):
 Licence Holder Change
CURRENT LICENCE HOLDER NAME:
10. Government Reference Numbers:
OR Park Use Permit # (Park/Protected land):
BC Land File # (Crown land):
NWPA #
Expiry date:
OR Parcel Identification # (Private land):
DFO Aquaculture Facility #
(yyyy/mm/dd)
11. Location of Operation:
 Land-based
 Isolated Pond
 In Freshwater Body
12. Type of Operation:
 Hatchery (finfish species)
 Hatchery (shellfish)
 Grow-Out
 Other (describe):
 U-Catch
SECTION B: SITE AND INFRASTRUCTURE INFORMATION
1. Site Category:
 Provincial Crown Land
 First Nation Reserve
 Provincial Park
 Other (describe):
 Private Land
 Federal Land
2. Geographic location of site:
3. Site Common Name:
4. Pacific Fishery
Management Area:
5. Canadian Hydrographic Service Chart (CHS)
Marine Chart Number (if water-based):
Sub Area (if applicable):
OR,
Topographical Map Number
(if land-based):
6. If the application area is surveyed, provide legal description of site (e.g. Land District and Lot Number):
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 2 of 15
7. If the application area is not surveyed, provide the metes and bounds description from a known surveyed point or
geographic reference (UTM or latitude and longitude):
Shape file submitted?
If available, provide a shape file geo-referenced to BC Albers projection (NAD 83)
8. GPS coordinates for the center of the application
area/tenure:
 Yes  No
Latitude:
Longitude:
9. Total area of the site (Hectares):
Current size:
Proposed size:
10. Intensive Use Area of site (Hectares):
(Attach worksheet showing calculations)
11. Extensive Use Area of site (Hectares):
12. Physical Structures (Improvements):
Complete table below describing all applicable structures. Attach another page if required. – FOR AMENDMENTS ONLY FILL OUT
FOR PHYSICAL STRUCTURES WITHIN 30m of a WATER BODY, IN A FRESHWATER BODY, and/or ON CROWN LAND REQUIRING
TENURE.
Purpose: Indicate the purpose of the infrastructure. Examples for buildings include: Office, Hatchery, Grow-out, Quarantine, etc.
Examples for tanks include: Fish Rearing, Quarantine, Solids Capture, Water Storage, etc. Examples for ponds include Fish Rearing,
Grow-out, Settling, etc.
TABLE 12.1
LAND-BASED INFRASTRUCTURE
PLEASE NOTE: Construction in association with fish and fish habitat may require redesign, relocation,
mitigation and/or a fish habitat survey review and approval prior to installation. See Part III, Section F.
IMPROVEMENT
PURPOSE
e.g.: Tanks 1
Buildings
Fish Rearing
CURRENTLY
LICENSED PROPOSED










Tanks


2






1
2
3
4
1
3
4
DIMENSIONS (m)
OF EACH STRUCTURE
0.7 x 0.7 x 0.5
TABLE 12.1 CONTINUED ON NEXT PAGE/…
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 3 of 15
TABLE 12.1 CONTINUED…
IMPROVEMENT
PURPOSE
CURRENTLY
LICENSED PROPOSED
Raceways


2






Constructed Ponds


2






1
3
4
1
3
4
OTHERS
DIMENSIONS (m)
OF EACH STRUCTURE
DESCRIPTION
TABLE 12.2
INFRASTRUCTURE WITHIN FRESHWATER BODY
PLEASE NOTE: Construction in association with fish and fish habitat may require redesign, relocation,
mitigation and/or a fish habitat survey review and approval prior to installation. See Part III, Section F.
IMPROVEMENT
PURPOSE
Containment
Structures
CURRENTLY
LICENSED PROPOSED








Work Floats


2






1
2
3
4
1
3
4
DIMENSIONS (m)
OF EACH STRUCTURE
TABLE 12.2 CONTINUED ON NEXT PAGE/…
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 4 of 15
TABLE 12.2 CONTINUED…
OTHERS
DESCRIPTION
SECTION C: MAPS AND DIAGRAMS
Attach the following maps and diagrams.
They must be submitted to scale and be
consistent with the other information in
this application. Please refer to the
Mapping Descriptions and Sample
Mapping in the Guide to Pacific
Freshwater & Land-Based Aquaculture.
Note: If drawings are larger than
11” x 17”, Transport Canada requires
that you enclose five (5) copies. For
drawings 11” x 17” or smaller, one (1)
copy will be sufficient.
Check each box to confirm that documents are attached.
1. General Location Map: A topographic map at a scale of 1:50,000 to
1:250,000 indicating the general location of area under application,
noting the location of significant geographic features, such as a lake,
mountain, road, community, etc.

2. Site Plan: A plan of the site identifying the location of buildings and
out-door infrastructure. Clearly indicate the location of the water
source(s) and discharge point(s), along with any water bodies
(including culverts and ditches) located on, or near the site.

3. Engineered Plan, for applications with proposed works in freshwater
bodies or within 30m of a water body: Any new or proposed
infrastructures/construction requires an engineered plan.

4. Top View Operational Diagram, for applications in freshwater bodies:
A 1:5000 scale topographical map showing the application boundary,
site improvements and metes and bounds description.

5. Side View Operational Diagram, for applications in freshwater
bodies: A scaled schematic diagram showing a side view of the
proposed operation, which includes all structures (based on season of
lowest water).

6. Flood Plain Map, for applications located within, or near a flood
plain: include a flood plain map.
(www.env.gov.bc.ca/wsd/data_searches/fpm/reports/regoff.html)

SECTION D: WATER USE
1. Will fresh water be used at this facility?
 Yes  No
If Yes, and if water source is surface water (not ground), provide the name of the water source:
2. If you already have a water licence at this site, please provide
licence number, or provide date of submission of an application:
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
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SECTION E: FIRST NATIONS CONSIDERATION
If the facility is on Crown land, please describe any contact you may have had, including the name of the First Nation(s)
and individuals contacted. Consult the consultative Area Database (CAD) Public Map Service for First Nations contact
information instructions and supporting information ftp://ftp.geobc.gov.bc.ca/pub/outgoing/CAD/CAD_Public_Map_Service-User_Guidance-Technical_Instructions.pdf.
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 6 of 15
PART II – INFORMATION FOR THE BC MINISTRY OF
FORESTS, LANDS AND NATURAL RESOURCE OPERATIONS (FLNR)
The following information, along with Part I and Part V is required for the review of the Provincial Crown Land Tenure
application or amendment to an existing tenure pursuant to the BC Land Act.
SECTION A: SITING CONSIDERATIONS
Applicants must respond to each consideration and may be required to provide additional information in some situations.
1. If water-based, does your proposal infringe on the riparian rights of an upland owner?
If Yes, the applicant is required to provide written consent from the private land upland owner to occupy the
site for the proposed term of the tenure.
2. Is the intended use consistent with approved local government bylaws for land use planning
and zoning?
 Yes  No
 N/A
 Yes  No
 Yes  No
If No, have you contacted the local government?
Provide details of communications and relevant correspondence with your application.
Provide the name of the local government(s) for the area under application:
SECTION B: ADDITIONAL CROWN LANDS INFORMATION
1. Is applicant or applicant’s spouse a provincial government employee?
2. Are all applicants Canadian Citizens or Permanent Residents;
or if a corporation, registered partnership, cooperative or non-profit society, is it registered in BC?
3. Is/Are applicant(s) 19 years of age or older?
4. For applications made by more than one individual:
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
 Yes  No
 Yes  No
 Yes  No
 N/A  Joint Tenant
OR
 Tenants in Common
Page 7 of 15
PART III – INFORMATION FOR
FISHERIES AND OCEANS CANADA (DFO)
The following information along with Part I and Part V is required for the review of the federal Aquaculture Licence
application or amendment to an existing licence pursuant to the federal Fisheries Act, Pacific Aquaculture Regulations.
NOTE: If you are requesting an increase or change in species or production
that requires an infrastructure modification, please ensure that Part I,
Section A, Question 9; and Part I, Section B, Question 12 are completed.
DFO requires the applicant(s), if an individual or a proprietorship or a person 'doing business as', submit date(s) of birth:
Applicant 1:
Date of Birth (yyyy/mm/dd):
Applicant 2:
Date of Birth (yyyy/mm/dd):
Has an application previously been submitted for this location?
 Yes  No
If Yes, provide details:
Government Reference Numbers:
Sec. 9 Notification – Tracking #
Sec. 9 Approval – Water File #
Water Licence – Water File #
Well ID #
ITC #
Land-Based Finfish Waste Control
Regulations Registration #
Does the British Columbia Riparian Areas Regulation apply to this project?
If Yes, are you requesting a variance?
File #
 Yes  No
 Yes  No
SECTION A: ELIGIBILITY FOR A FRESHWATER/ LAND-BASED AQUACULTURE LICENCE
Eligibility for a federal Freshwater/ Land-based Aquaculture Licence requires adherence to general Conditions of Licence.
The general Conditions of Licence for Freshwater/ Land-based aquaculture can be found at:
http://www.pac.dfo-mpo.gc.ca/aquaculture/licence-permis/fresh-douce-eng.html
This completed document will form the site management plan on which your aquaculture licence conditions will be
based.
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 8 of 15
SECTION B: WATER
1. Water sources: Check all that apply



Surface Water (Complete question 2)
Groundwater
Municipal
Other (describe):

2. Surface water intake details:
CURRENTLY
LICENSED
PROPOSED
WATER TYPE
(FRESH,
BRACKISH,
MARINE)
1


2


3


GOVT ID
(WATER ACT LICENCE #)
MAXIMUM
WITHDRAWAL
RATE (L/sec)
GPS COORDINATES
Name of Water Body:
Ensure your intake is screened according to the appropriate reference documents.
3. Water discharge: Check all that apply



Surface Water Outfall (Complete question 4)
Ground Infiltration
Municipal Sewer
Other (describe):

PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 9 of 15
4. Surface water outfall details:
CURRENTLY
LICENSED
PROPOSED
WATER TYPE
(FRESH,
BRACKISH,
MARINE)
1


2


3


GOVT ID
(WATER ACT LICENCE OR
AUTHORIZATION #)
MAXIMUM
DISCHARGE
RATE (L/sec)
GPS COORDINATES
Name of Water Body:
5. Have you applied for a permit under the Environmental Management Act?
 Yes
(Ref. File #
)
 No
 N/A
Provide details:
SECTION C: SPECIES AND PRODUCTION
SPECIES
COMMON NAME
SPECIES
(SCIENTIFIC) NAME
ANNUAL
PRODUCTION
ESTIMATE (t)
CURRENTLY
LICENSED
PROPOSED
SOURCE WITHIN
TRANSFER
ZONE 1
SOURCE OUTSIDE
TRANSFER
ZONE 1
1. Annual Expected Production:
Ex. Rainbow trout
Onchorhyncus mykiss
50




















ESTIMATED DATE
OF STOCKING
TABLE CONTINUED ON NEXT PAGE/…
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 10 of 15
TABLE CONTINUED…
















1Note:
If an aquaculturalist intends to take animals from the wild, or to transfer in any other manner (outside of transfer zones, where
applicable), into an aquaculture facility in order to undertake the activity of aquaculture, they might require, an Access Permit for the Purposes of
Aquaculture and/or an Introductions and Transfers Licence from Fisheries and Oceans Canada. More information on Access Permits, transfer
zones, and/or Introductions and Transfers is available on the internet.
http://www.dfo-mpo.gc.ca/aquaculture/regions/pac/introduction-eng.htm
2. Are any of the currently licensed, or proposed species finfish, which are destined for marine grow-out?
 Yes  No
SECTION D: FACILITY OPERATION
PURPOSE OF CULTURE
1. What is the purpose of culture for each proposed species (e.g. Sale to other Aquaculturists, Direct to Food Market,
etc.)?
EFFLUENT TREATMENT
2.
Will you be recirculating any water on site?
 Yes  No
3. Provide a detailed description of any effluent treatment works (UV, ozone, biological and/or mechanical filtration)
and/or monitoring occurring or proposed on site:
SECTION D:, 3. CONTINUED ON NEXT PAGE/…
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 11 of 15
SECTION D:, 3. CONTINUED…
SECTION E: FISH HEALTH
For finfish destined for transfer to culture facilities located in open water systems – marine or freshwaters - the
applicant must submit a Health Management Plan (HMP) based on a template available from the Department. Cultured
shrimp are also subject to this HMP requirement.
1.
A Health Management Plan is attached:
 Yes  No
If you answered No to question E1, it is understood that your finfish will not be transferred to open water systems for any stage
of their lifecycle.
SECTION F: FISHERIES PROTECTION
Fisheries and Oceans Canada – Aquaculture Management Division (DFO - AMD) is responsible for the sustainable
management of aquaculture in British Columbia.
Like other types of industrial development taking place in and around water, aquaculture projects have the potential to
affect fish and fish habitat.
Aquaculture activities must not result in harm to a Species at Risk Act (SARA) listed species, their residence or their
critical habitat, as defined in the associated Recovery Strategy, or Action Plan.
1. Does the proposed project:
a) Involve the construction or modification of any components within 30 m of the high water mark of a watercourse or
water body (this includes intakes, outfalls or water crossings)?
 Yes
 No, go to question (b)
b) Have downstream impacts on water quality or water quantity?
 Yes (or maybe)
 No (no additional information is required)
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 12 of 15
PART IV – INFORMATION FOR TRANSPORT CANADA (TC)
The following information, along with Part I and Part V is required for the review of the federal Navigation Protection Act
(NPA) approval or amendment to an existing approval pursuant to the NPA.
SECTION A: SITING CONSIDERATIONS
Applicants may be required to provide additional information in some situations.
SECTION B: ADDITIONAL TRANSPORT CANADA INFORMATION
1. Waterway Name:
Width (m):
Depth Range (m):
2. Nearest Community:
3. Is this Work:
 Proposed
 Existing
 Modification of Existing Work
4. To help with the review process, please include the following if available (check those you have attached):
 Photographs at the site of the proposed/existing work and surrounding area
 Environmental Assessment documents (if any)
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 13 of 15
PART V – INFORMATION FOR ALL AGENCIES
All applicable components of this application package
must be complete. Incomplete applications will be
returned to applicant. Applicable fees must be submitted
at time of application.
PROVINCIAL FEES:
Please refer to Guide to the Pacific Freshwater/Land-based
Aquaculture Application “Application Checklist” to confirm
that you have completed the sections of this application
that are needed for the type of application you are making
(i.e. New, Amendment, Change).
Note that the current fee schedule does not include the taxes that apply.
New site applications: http://www.for.gov.bc.ca/Land_Tenures/documents/cabinet/fees-land.pdf
Amendment applications: http://www.for.gov.bc.ca/Land_Tenures/documents/cabinet/fees-misc.pdf
FORMS OF PAYMENT:
●
●
●
Cheques or Money orders must be in Canadian Funds to Minister of Finance.
FrontCounter BC will not accept personal cheques drawn on US banks, regardless of what currency.
Payment will not be accepted even if it has “CDN Funds” handwritten on the cheque.
Debit Card (in-person only).
Visa and MasterCard payments are accepted in-person or over the telephone. To locate a FrontCounter BC office,
visit the website at http://www.frontcounterbc.gov.bc.ca/contact/ or call the toll free number 1-877-855-3222.
PLEASE NOTE: Additional items may be required (e.g. Advertising, Security Deposit, Proof of Insurance, Letter of
Consent). Some items may have additional associated costs or require additional processing time.
DISCLOSURE:
The information you provide may be subject to the following legislation: British Columbia Freedom of Information and Protection of Privacy Act (FOIPP Act); the
federal Access to Information Act; and the federal Privacy Act. The personal information collected by the Government of BC is collected under the authority of section
26 (c) of the FOIPP Act and will be used to process your application(s) and will be shared only with the necessary government agencies needed to provide you with
the service that you have requested. If you have any questions regarding the handling of your personal information, please contact the Manager, Privacy, Information
Access and Records Management for the Province of BC c/o FrontCounter BC, 2080a Labieux Road, Nanaimo, BC V9T 6J9 and/or the Director, Access to Information
and Privacy Secretariat at the Department of Fisheries and Oceans Canada and Transport Canada.
The Province of British Columbia, Fisheries and Oceans Canada, and Transport Canada do not consider the information submitted in this form to be confidential
unless it is subject to the privacy protection of the Freedom of Information and Protection of Privacy Act or the Access to Information Act.
I understand that the information supplied will be used to review my applications under the BC Land Act, BC Fisheries Act,
federal Fisheries Act and the federal Navigable Waters Protection Act and information will be shared amongst the other
agencies, First Nations and/or with the public.
IMPORTANT: Federal regulations require that applications submitted on behalf of a company be signed by a company director.
Please email aquaculture.licensing@dfo-mpo.gc.ca for direction regarding supporting documentation.
Signature(s) of applicant(s)
or authorized representative
Printed name(s) of Applicant(s)
or authorized representative*
Date
*If signature is by an authorized representative please supply a letter granting authorization to act on behalf of the applicant.
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 14 of 15
Submit completed application, and additional
supporting information (if applicable) to:
BY EMAIL:
Email Subject line:
Attachments:
Proponent Name, Application Type (date will be on the email)
Prefer the application and attachment to come all in one
PDF document. If not, name as following:
Proponent_Application Type_1of2
Proponent_Description of Supporting documents_2of2
Email to:
Fees:
Application Signature:
frontcounterbc@gov.bc.ca
IF FEES ARE APPLICABLE, CLIENT MUST CONTACT FRONTCOUNTER BC
BY TELEPHONE WITH CREDIT CARD INFORMATION PRIOR TO
SUBMITTING THE APPLICATION ELECTRONICALLY. DO NOT INCLUDE
PAYMENT (CREDIT CARD) INFORMATION VIA EMAIL OR FAX.
Inserting names into the Signature area of the PDF application form will
be deemed as signed when document is sent by email.
IN PERSON:
Any FrontCounter BC office.
Visit http://www.frontcounterbc.gov.bc.ca for the location nearest you.
BY MAIL:
FrontCounter BC, 2080a Labieux Road, Nanaimo, BC V9T 6J9
PLEASE RETAIN A COPY OF THIS APPLICATION FOR YOUR RECORDS
APPLICATIONS ARE NOT TRANSFERABLE
THE SUBMISSION OF THIS FORM DOES NOT IN ANY MANNER CONVEY ANY RIGHTS TO USE OR
OCCUPY CROWN LAND AND/OR CONDUCT REQUESTED ACTIVITIES
PACIFIC FRESHWATER/LAND-BASED AQUACULTURE APPLICATION
EFFECTIVE DATE: JULY 31, 2014
Page 15 of 15