Pacific Agricultural Certification Society
3402 32nd Ave. Vernon, BC V1T 2N1 phone 250.558.7927 fax 250.558.7947 pacs@certifiedorganic.bc.ca
Land Use/History Questionnaire for Crown Lands
This form is to be completed by operators who are including crown land in their organic production, whether for forage
or other uses. This form can be completed on computer (save this form onto your harddrive before filling it in; to fill
in put cursor in grey boxes) or with a black ink pen. Do not use pencil. If you run out of room, attach another file
or sheet of paper. If you have made many changes in your production request a Farm Plan form (rather than using this
renewal update form), as it will save on inspection fees. Keep a copy of this form for your records. Section marked VO
are for the verification officer only.
1. Applicant name:
2. Farm name:
4. Description of Crown Land tenure:
Agricultural lease
Other:
Grazing lease
Grazing licence
5. How long have you held this tenure?
3. Date yyyy/mm/dd:
Office Use Only
Date received:
Date reviewed:
File #:
Reviewed by:
6. What government agency is responsible for this tenure?
7. For agricultural lease, describe the use plan, lot and lease number:
8. For grazing lease, provide description of parcel(s) with the current or proposed use plan:
VO
only
Original Plan plus Renewal
Update are accurate
This Section above is
accurate
PACS Land Use/History Questionnaire for Crown Lands
Page 1 of 3
See narrative for details
Ver02-12/13/2006
Confidential when completed
Pacific Agricultural Certification Society
3402 32nd Ave. Vernon, BC V1T 2N1 phone 250.558.7927 fax 250.558.7947 pacs@certifiedorganic.bc.ca
9. For grazing licence(s) submit Animal Unit Months (AUM’s) of grazing and grazing schedules as per maps item #10.
10. Attach maps of agricultural leases and/or grazing licence(s). For grazing licence(s), attach Forest Service map with
areas under tenure well marked.
Maps are attached Maps are being sent via post
11. Have there been any silvacultural or other practices applied to the land under tenure that involved the use of materials
or practices that are prohibited in the BC Certified Organic Program?
If yes, please explain:
Yes
No
Unsure
12. Is the crown land under tenure subject to weed control measures?
Yes No Unsure
If yes, what agency is responsible and what measures are/will be taken to offset the lack of grazing of treated areas?
13. Describe your source of information concerning the history of this crown land:
14. Use this area to provide additional information:
VO
only
Original Plan plus Renewal
Update are accurate
This Section above is
accurate
PACS Land Use/History Questionnaire for Crown Lands
Page 2 of 3
See narrative for details
Ver02-12/13/2006
Confidential when completed
Pacific Agricultural Certification Society
3402 32nd Ave. Vernon, BC V1T 2N1 phone 250.558.7927 fax 250.558.7947 pacs@certifiedorganic.bc.ca
15. Affirmation
I understand that this completed document is confidential information according to the policies of the BC Certified Organic
Program. Membership and certification status is public information.
Signed:
Print name:
Date:
16. VERIFICATION OFFICER AFFIRMATION
All information in this report is accurate to the best of my knowledge and is based on my observations, review of
documents and operator interview. All compliance assessments are made in reference to the COABC organic
management standards and policies of the Pacific Agricultural Certification Society.
Information contained in this report is confidential between the Verification Officer, the inspected party, and the certification
body. This report does not constitute certification or consultation, nor should it be used for promotional purposes.
Signed:
Print Name:
PACS Land Use/History Questionnaire for Crown Lands
Page 3 of 3
Date:
Ver02-12/13/2006
Confidential when completed