ENVIRONMENTAL PROTECTION AUTHORITY
Resource Consent Application Form
For office use only:
Private Bag 63002Application number:......
Wellington 6140Date received:......
This form must be accompanied by a completed Nationally Significant Proposals Application Form.
All legislative references relate to the Resource Management Act 1991 (RMA) unless stated otherwise.
In accordance with Schedule 4 of the RMA, all information provided in this application must be specified in sufficient detail to satisfy the purpose for which it is required.
You must serve the relevant local authority with notice of this matter together with notice of its lodgement with the EPA.
Part I: Application for Resource Consent
Sections 145 (1) (a) and (5), Section 88 and Schedule 4, RMA.
This part of the form reflects the information requirements of Form 9 of the Resource Management (Forms, Fees, and Procedure) Regulations 2003.
This application is for the following type(s) of resource consent (section 87) (please tick all that apply):
Have you completed and attached all relevant council application forms?
Provide a description of the activity to which the application relates.
Attach, in accordance with the Fourth Schedule of the RMA, an assessment of environmental effects in such detail as corresponds to the scale and significance of the effects that the activity may have on the environment.
Attach any information required to be included in this application by the district plan, the regional plan, the RMA or any regulations made under the Act.
If relevant, attach any additional information required for resource consent for a subdivision (Schedule 4 (4)).
If relevant, attach any additional information required for resource consent for reclamation (Schedule 4 (5)).
Part II: Signature
I hereby certify that, to the best of my knowledge and belief, the information given in this application is true and correct.
I acknowledge that I have read and understood any requirements detailed on the Nationally Significant Proposals Application Form. I understand that the EPA can recover any actual and reasonable costs associated with processing this application.
If the EPA determines that any application for a resource consent or an application for a change to or cancellation of the conditions of a resource consent is incomplete, it may return the application.
I understand that I must serve the relevant local authority with notice of this matter together with notice of its lodgement with the EPA.
Signature of applicant (or person authorised to sign on behalf of application)Date
Note: Please complete the checklist on the following page prior to lodging this application. The checklist is designed to assist you in providing all relevant information and is not intended to be an exhaustive list of requirements.
ENVIRONMENTAL PROTECTION AUTHORITY
Resource Consent Application ChecklistIn accordance with the standard Form 9 of Form 9 of the Resource Management (Forms, Fees, and Procedure) Regulations 2003 requirements, the following should be provided: / ✓
A discussion of the actual and potential effects of the matter on the environment in sufficient detail to satisfy the purpose for which it is required.
A discussion regarding how actual or potential effects of the proposal will be avoided, remedied, or mitigated.
The full name and address of each owner or occupier of the site(s).
Evidence that all relevant resource consents required for the matter have been applied for.
An assessment of the proposed activity against the matters set out in Part 2 of the RMA 1991.
An assessment of the proposed activity against any relevant provisions of a document referred to in s 104(1)(b).
*Plans and elevations relevant to the proposal.
*A list of persons who are potentially adversely affected by the proposal.
If the application is for a subdivision consent, the following has been included:
- the position of all new boundaries
- the areas of all new allotments
- the locations and areas of new reserves (including esplanade reserves or esplanade strips)
- the locations of any existing esplanade reserves, esplanade strips, and access strips
- locations of any parts of the bed of a river or lake to be vested in the territorial authority
- locations and areas of any land within the coastal marine area; and
- the locations and areas of land to be set aside as new roads.
If the application is for reclamation, the following has been included:
- the location of the proposed reclamation
- the positions of all new boundaries, and
- the portion of the area (if any) to be set aside as an esplanade reserve or esplanade strip.
*These points are recommended to help with the processing of your application but are not required.