Environment and
Sustainable Resource Development
Application for Commercial/Industrial/Recreational Dispositions
Please Print Or Type
Application Fees:
Commercial/Industrial DML :
$1,800+GST
Recreational DML: $900+GST
Mapping Fee: $125
EFR attached?
Yes
No
N/A
[See reverse for applicable purposes]
Department Miscellaneous Lease (DML)
Department File Number:
Plan Confirmation Number:
FNC Number:
Miscellaneous Permit (MLP)
Recreational Lease (REC)
Applicant
Applicant's File Number
Address
City/Province
Postal Code
Contact Person/Agent Same As Above
or
Address
City/Province
Postal Code
Joint Tenants OR
Tenants In Common
Please see reverse for definition.
Work Telephone: (
Home Telephone: (
Telephone:
Fax:
Agent's File Number
Length of Time Land Required:
)
)
years
months
Land being applied for [Attach Schedule if insufficient space]
Name of Subdivision
QTR/LS
Subdivision Plan Number
SEC
TWP
RGE
MER
Block
Lot
QTR/LS
SEC
TWP
Parcel
RGE
MER
Project Name [if applicable]:
Purpose:
Existing Developments [if any]:
Does this application include watercourse crossings regulated under the water act (ministerial) regulations' code of practice for pipelines
and telecommunication lines watercourse crossings?
Yes
No
If yes, the applicable water act notice must be submitted with this application.
Proposed developments total area:
AC/HA
M x
Site Dimensions:
M
If a tourism and recreational development is being proposed, please see reverse for further information.
Are you an employee of the government of alberta or member of the legislative assembly?
Dept.:
Yes
No
Position:
Have you attained the age of 18 years?
Yes
No
Are you a Canadian citizen or landed immigrant?
Yes
No
For Departmental Use Only
Authorization is hereby granted to enter upon and occupy the public land as
described on this application and as shown on the attached sketch subject to the
attached conditions.
Signature
Print Name
$
Date
Amount Enclosed
[Non-Refundable]
Date
Client I.D. Number:
Attached Plan/Sketch?
Technical Services Section
File Records
Conflictions?
Yes
No
The director, Public Lands Act
Yes
No
Mylar
Yes
No
GLIMPS
Application packages can be submitted electronically to esrdsurfaceactivityapplications@gov.ab.ca
Incomplete applications may be returned to the applicant without being processed.
Application fee must be submitted with the application.
Personal information in this form is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act and will be used to administer the Public
Lands Act and its associated regulations. This form is a public record and is available to anyone. All information contained on this form (including personal information) may be disclosed by
Alberta Environment and Sustainable Resource Development to anyone requesting a copy in accordance with sections 166-167 of the Public Lands Administration Regulation. For further
information about the collection and use of this information, please contact 780-427-3570.
Apr 2, 2015
Application for Commercial Dispositions
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© 2015 Government of Alberta
ESRD/Application for Commercial Dispositions
Application Plan Requirements
Every application must obtain a sketch or a plan of a survey as prepared by an Alberta Land Surveyor. The plan requirements
can be found on the Sustainable Resource Development website: esrd.alberta.ca. Search for 'Plan Information Public Lands'.
Enquires about plan requirements should be directed to:
Provincial Programs Branch
Operations Division
2nd Floor, South Tower, Petroleum Plaza
9915 – 108 Street
Edmonton, Alberta, T5K 2G8
Tel. (780) 427-3570
Fax (780) 422-4252
Definitions
Joint Tenants
Joint tenancy is where upon the death of one title holder, the
deceased's interest passes to the other title holder rather than
the deceased's estate. (Joint tenancy is the usual agreement
in a husband and wife title.)
Tenants in Common
Tenants in common are where upon the death of one
title holder, the deceased's interest passes to the
deceased's estate and not to the other title holder.
Tourism and Recreational Development
Applications for tourism and recreational development are reviewed through the three-stage Alberta Tourism Recreational
Leasing (ATRL) process. The application must be submitted with supporting documents consisting of a covering letter, a
completed lease application form, a non-refundable lease application fee, and twelve copies of a detailed information package.
Additional application submission requirements are outlined in the Alberta Tourism Recreation Leasing Process document,
specifically Appendix B. This document can be found at Alberta Tourism, Parks and Recreation > Tourism > Land
Development.
Information regarding the ATRL process may be obtained from:
For business assistance contact:
Industrial & Commercial Land Use Section
Land Management Branch
Sustainable Resource Development
3rd Floor, South Tower, Petroleum Plaza
9915 – 108 Street
Edmonton, Alberta, T5K 2G8
Tourism Product Development Branch
Alberta Tourism, Parks and Recreation
6th Floor, Commerce Place
10155 – 102 Street
Edmonton, Alberta, T5J 4L6
Tel. (780) 422-1362
Tel. (780) 427-3570
Fax (780) 427-1185
An Environmental Field Report (EFR) is required for the following purposes:
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

Industrial Campsite
Commercial Campsite
Plant Site
Landfill Site [after soil testing]
Mill Site
Transfer Site
Tower/Repeater Site
Power Substation Site
Apr 2, 2015
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
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Compressor Site
Rig Storage
Pipe Storage
Log Storage
Tank Storage
Service Station Site
Land Farm Site
Application for Commercial Dispositions
© 2015 Government of Alberta
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