Community Infrastructure and Housing Annual Report

PDF Version - Fill & Print (185 Kb, 1 Page)

Form Instructions

DCI# 41701.GCIMS (2015-2016)

 

Tribal Council Name

Tribal Council Number

Band Name

Band Number

Site Name

Site Number

 Total Units must equal Total Housing Units as denoted in Previous and Current year; if not, please add justification in comments

AANDC Use Only

  • Site Number
  • Year
    • Previous
    • Current

Housing Units Without:

  • Electrification
  • Solid Waste Service
  • Road Access

Community Services

  • Broadband
    • Yes
    • No

Housing Plan

  • Housing Plan
    • Yes
    • No

Housing Units

  • Total Units

Housing Conditions

  • Replacement Required
  • Major Renovations Required
  • Total Adequate Units

Comments:

 

Site Number

Year

  • Previous
  • Current

Water Servicing

  • Water Source
    • Ground
    • Surface
    • Total Units
  • Water Delivery
    • Community System
    • Individual System
    • Truck A
    • Truck B
    • No Service
    • Total Units

Sewage Servicing

  • Sewage Disposal Destination
    • Treatment Facility
    • Ground
    • Total Units
  • Mode of Sewage Collection
    • Piped Community
    • Piped Individual
    • Trucked
    • No Service
    • Total Units

Comments:

 

The information provided is accurate to the best of my knowledge.

Business Contact - Given Name

Business Contact - Family Name

Title

Tribal Council/Firm/First Nation Name

Date (YYYY/MM/DD)