Government of New Brunswick

Please note that an application must be filled out for each property that an exemption is being applied for.

 

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  Telephone Number:


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 (if different from applicant)

 

 

  Telephone Number:

 

 

 

 

 

 

 

Wellfield Maps may be viewed at Department of Environment and Local Government office or Service New Brunswick Registry Offices.

 

Property:


PID Number(s)

 

Zone (A, B or C)

 
 A
 B
 C
 
 
 A
 B
 C
 
 
 A
 B
 C

Your Property Identification Number (PID) may be determined by referring to your property tax bill or phoning Service New Brunswick (SNB) at 1-888-762-8600.

A map must be included for each property.

 

Type of Land Use:

Please check one of the following that best describes your property's land use:


 
 Residential
 Industrial
 Forestry
 Commercial
 Agriculture
 Institutional
 Other

 

Description of Land Use:

Briefly describe the use of the property and whether the use is existing or proposed (ie. existing service station, existing dry cleaning operation, new sawmill, etc.)


 

Description of Chemical Use/Storage:

Provide a list of chemicals or other substances (including petroleum products) that will be used or stored at the site with typical storage quantities.


 

Note:  You must include the age of all petroleum storage tanks on the property (this can be found on a metal tag attached to the oil tank), the installation date and the warranty expiration date if known.



Have you previously requested an exemption from the Minister?


 
 Yes
 No

If so, please quote the file number


 

I hereby certify that the above information is correct to the best of my knowledge