HomeMy WebLinkAboutSubdivision - Request for ExtensionREQUEST FOR EXTENSION
SUBDIVISION APPLICATION
County of Newell | Request for Extension – Subdivision Application | Land Use Bylaw 2016-21 Page 1 of 1
183037 RR145 (Box 130), Brooks, AB T1R 1B2
Office Hours: Mon-Fri 8:00 a.m. – 4:30 p.m.
Email: development@newellmail.ca
Web: www.countyofnewell.ab.ca
Phone: 403-362-3266
Revised 2026-01-09
File No.
Date of expiry
1. APPLICATION INFORMATION
Previous Extension Approval: Yes No Extension Period Request: (not to exceed one year)
Fee Submitted (refer to the Schedule of Fees Bylaw): 1st Request 2nd Request 3rd Request
2.CONTACT INFORMATION
Registered Owner of Lands:
Mailing Address: Postal Code:
Phone: Email:
Name of Agent (Person authorized to act on Registered Owner’s behalf)
Mailing Address: Postal Code:
Phone: Email:
3.LEGAL LAND DESCRIPTION
All/Part of the Quarter:NE NW SE SW Section: Township: Range: W4 (e.g. SW-20-18-14-W4)
Being all/part of Lot/Unit: Block: Plan:
Rural address (if applicable):
4.REASON FOR THE REQUEST
Please outline the reason(s) for the request for extension:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
5.APPLICANT / REGISTERED OWNER SIGNATURE
Date: _____________________ Applicant Signature: ______________________________________________
Registered Owner: _______________________________________________________________________________
(Required, if different from applicant) Print Name Signature
OR
Written approval has been submitted by the registered owner stating that the applicant is authorized to sign the application form.
Date written approval was submitted: _____________________
Collection Statement: The personal information collected on this form will be used to process and issue permits and for safety codes compliance monitoring and verification. This collection is
authorized under section 4 (c) of the Protection of Privacy Act and will be protected by section 10 of the Protection of Privacy Act and section 63 of the Safety Codes Act. It will be used to
process the subdivision application – request for extension and to contact the applicant when required. The name of the applicant and nature of the application may be included on reports
provided to the municipality or made available to the public as required or allowed by legislation. Please direct any questions about this collection to the Privacy Officer for the County of
Newell at 403-362-3266 or administration@newellmail.ca.