Privacy Note: Council is collecting the information on this form so that it may consider your application. The information is only used by Council for this purpose and will not be disclosed unless required under law.

Applicant Details
First name: / Surname:
Postal address:
Suburb: / Postcode:
Phone number/mobile:
Email address:
Being the registered proprietor/s (hereinafter referred to as ‘the owner’) of all that piece of land being:
Lot Number: / Plan Number:
Being (part of) Crown Allotment:
Section: Parish of:
Commencement Date of Works:
Builder:
Site Contract Name:
Site Contact Phone Number:
Being the land more particularly described in Certificate of Title:
Volume: / Folio:
Situated and known as:
Required Information

Copy of Title or Plan of Subdivision

Building Layout Plan

And delineated on the building plan attached, request approval for the erection and/or

placement of: (please tick)

A building

A wall

A bridge

A fence

An embankment

Filling

Material

Machinery

Any other structure

Constructed over a drainage easement.

More particularly, described as (general description):

Title Requirement

A Title for the property is often necessary for Build Over Easement applicationsbecause it contains the Legal Description for the property. This is often required to ensure that the correct allotment is being processed.

Incomplete Applications

Please note, if the required information is not submitted, the applicant will be notified within 5 working days of submitting the application. If the missing information is not provided within 15 working days of Council’s notification, the application will be closed and there will be no refunds of application fees.

Signature

Signature (Registered Proprietor):

Date:

Amount payable $100.00 (GST Free)
______

Payment Options
In Person: Civic Centre, 25 Liebig Street, Warrnambool.
Cheque/Money Order: (enclosed & payable to Warrnambool City Council)
Credit Card: If you wish to pay for your permit application by credit card, please tick the box & Customer Service staff will ring you upon receipt of your enquiry to arrange payment.

Build Over Easement PermitApplicationsCanBe Submitted:

ByPosttoPOBox198,WarrnamboolVictoria3280

InPersonattheCivicCentreat 25LiebigStreet,Warrnambool

Byemailto

Difficulties Completing Form

If you are having difficulties completing this application or have questions regarding the Build Over Easements application process please ring Council’s Technical Services Branch on (03) 5559 4800.

OFFICE USE ONLY / Receipt Date: / Receipt No. / CSO Initials: / Amount: / Processed:
 YES  NO

Civic Centre 25 Liebig StreetTelephone (03) 5559 4800Website

Warrnambool Victoria AustraliaFacsimile (03) 5559 4900ABN 44 594 264 321

P.O. Box 198 Warrnambool VIC 3280AUSDOC DX 28005