Postal Addressasset Managementinternet

Postal addressAsset ManagementInternet

PO Box 159Ph:07 3205 0555

Caboolture QLD 4510Fax:073205

ABN:92 967 232 136

Applicant details:

Name:
Postal address:
Home number: / Mobile: / Work:

Note: Contact numbers which you provide may be used to update council’s records.

Additional streetlight and power pole details:

Location of pole:
Power pole number:

Reason for request:

Customer summary:

When filling out this application it is necessary for you to establish on which power pole you would like the streetlight placed and identify it to council by its location and pole number. If a power pole does not exist, then identify the suggested location for the new pole and streetlight.
As a streetlight may impact on a number of homes, it is essential that the opinion of the owners of homes in the vicinity of the proposed streetlight is sought. There is provision on this form for their views. This must be completed prior to returning this application to council.
The erection of an additional streetlight may cause glare. Where a complaint is received regarding such glare, the complainant is responsible for meeting the cost of rectifying the situation in accordance with Council Policy 10-2150-012 ‘Shading of Streetlights’.

I / we acknowledge that the erection of additional streetlighting may cause glare and have brought this to the attention of adjoining and opposite owners named in this form.

Signature: / Date:

Privacy statement

MoretonBay Regional Council is collecting your personal information for the purpose of assessing your application for additional streetlighting. The collection of this information is authorised under the Local Government Act 2009. Your information will not be given to any other person or agency unless you have given us permission or we are required by law.

Statement by owner adjacent (1):

I / we :
of:
agree / disagree with the proposal for extra lighting in:

and acknowledge that the erection of streetlights may cause glare.