Applicant Details
Owner Company / Authority Agent of the Owner
PLAN TO ACCOMPANY APPLICATION FOR PERMIT
Location of Council land and area of closure, occupation or use
Applicant NamePostal Address
Suburb / State / Postcode
Contact Name
Email / Mobile
Details of Work
Dates of Occupation / Start Date / End DateDescription of Building Work
Description of Hoarding Structure
Location of Hoarding
Area of Public Space Occupied
Dimensions Required
PLAN TO ACCOMPANY APPLICATION FOR PERMIT
Location of Council land and area of closure, occupation or use
Accompanying Documents
PLAN TO ACCOMPANY APPLICATION FOR PERMIT
Location of Council land and area of closure, occupation or use
Has a Building Permit been issued?
Yes
PLAN TO ACCOMPANY APPLICATION FOR PERMIT
Location of Council land and area of closure, occupation or use
Has Consent and Report been issued?
Yes
PLAN TO ACCOMPANY APPLICATION FOR PERMIT
Location of Council land and area of closure, occupation or use
Site Plan attached if Consent and Report not issued
Yes
PLAN TO ACCOMPANY APPLICATION FOR PERMIT
Location of Council land and area of closure, occupation or use
Traffic Management Plan attached
Yes
PLAN TO ACCOMPANY APPLICATION FOR PERMIT
Location of Council land and area of closure, occupation or use
Public Liability Insurance current certificate attached
Yes
PLAN TO ACCOMPANY APPLICATION FOR PERMIT
Location of Council land and area of closure, occupation or use
Declaration by Applicant
I confirm that I have read the Fact Sheet detailing the conditions required to be complied with, in the issue of a Local Law Permit, and agree that I will comply with those conditions.
To my knowledge all necessary building and/or planning permits have been obtained.
Request invoice for payment of fees, to be issued on receipt of your application.
Signature of Applicant / DatePrint Name
Details required on plan
· Street: road, highway, carriageway, lane, footway, footpath, square, court, alley, right of way and any part of a road reserve.
· Nearest street intersection
· Any street furniture, parking signs, bins, power poles, pits, bus stops/shelters, etc
· Distance in metres remaining for pedestrians and/or cars whilst works are in place.
A minimum of 1.5m for pedestrians and 3m for cars must be maintained at all times.
North