The hills shire CounCil
3 Columbia Court Baulkham Hills NSW 2153 PO Box 7064, Baulkham Hills BC 2153
Phone 02 9843 0555 email [email protected] Facsimile 02 9843 0409 www.thehills.nsw.gov.au
Application for Design Compliance Certificate
(Engineering Works) Made under Section 190(C)(1)(a) of the Environmental Planning & Assessment Act 1979.
SECtiON 1 - PrOPErty DESCriPtiON*
SECtiON 2 - APPliCANt’S DEtAilS*
SECtiON 3 - BuilDEr’S DEtAilS
SECtiON 4 - OWNEr’S DEtAilS*
HOW tO COMPlEtE tHiS FOrM:
1. Ensure all fields are completed correctly.
2. Fields marked with an * are mandatory and must be completed.
3. For assistance in completing this form please contact Council on 9843 0555.
4. Details must be printed in BLOCK LETTERS with black ink.
5. Once completed you can submit this form by mail, fax or in person. Refer to Section 9 for details.
OFFiCE uSE ONly
Fees:
Date received:
DA No.
CC No.
Receipt No.
Address: lot:
Address:
Address:
Address:
Name:
Name:
Name:
Suburb: DP (or SP):
Suburb: Postcode:
Suburb: Postcode:
Suburb: Postcode:
Home phone: Work phone: Mobile:
Home phone: Work phone: Mobile:
Home phone: Work phone: Mobile:
Email: Fax:
Email: Fax:
Email: Fax:
Signature: Date:
Signature: Date:
Signature: Date:
Signatures of ALL owners - I/We own the subject land and consent to Council Officers entering the premises for the purpose of carrying out inspections in conjunction with this application, without first giving written notice. noTe: If the owner is a company or owners corporation, its Common Seal must be stamped over the signature(s) otherwise the Managing Director must clearly indicate the ACN
The hills shire CounCil
3 Columbia Court Baulkham Hills NSW 2153 PO Box 7064, Baulkham Hills BC 2153
Phone 02 9843 0555 email [email protected] Facsimile 02 9843 0409 www.thehills.nsw.gov.au
Application for Design Compliance Certificate
(Engineering Works) Made under Section 190(C)(1)(a) of the Environmental Planning & Assessment Act 1979.
SECtiON 5 - CONSENt*
SECtiON 6 - CONStruCtiON CErtiFiCAtE
SECtiON 7 - DESCriPtiON OF DEvElOPMENt*
SECtiON 8 - tyPE/DEtAilS OF CErtiFiCAtE rEquirED*
Give details below of the specific conditions of Development Consent/Complying Development Certificate which have been complied with, the matter the condition relates to and the applicable standards/instruments that the matter is required to comply with.
You can lodge this completed application by:
FAX: (02) 9843 0409 MAil: the Hills Shire Council
PO Box 7064, Baulkham Hills BC 2153
in Person AT CounCil’s CusToMer serViCe CenTres:
Council Administration Building, 3 Columbia Court Baulkham Hills NSW 2153 Castle Hill Library, Cnr Castle and Pennant Streets, Castle Hill
Dural Library, Pellitt Lane, Dural
Vinegar Hill Memorial Library, 29 Main Street, Rouse Hill Town Centre
If you require further information regarding this application, please contact Council on 9843 0555.
SECtiON 9 - lODgEMENt iNFOrMAtiON
Development Consent No
Certificate No
OR Complying Development Certificate No
Date of issue
Date of Determination
The hills shire CounCil
3 Columbia Court Baulkham Hills NSW 2153 PO Box 7064, Baulkham Hills BC 2153
Phone 02 9843 0555 email [email protected] Facsimile 02 9843 0409 www.thehills.nsw.gov.au
Application for Design Compliance Certificate
(Engineering Works) Made under Section 190(C)(1)(a) of the Environmental Planning & Assessment Act 1979.
SECtiON 10 - PrivACy NOtiFiCAtiON
The personal information that Council has collected or is collecting from you is personal information for the purposes of the Privacy and Personal information Protection Act (PPiPA) 1998.
The intended recipients of the personal information are:
• Officers within the Council,
• Data service providers engaged by the Council from time to time;
• Any other agent/contractor of the Council; and
• Other Statutory Authorities.
The supply of the information by you is not voluntary. Council has collected this personal information from you in order to process your request.
You may make application for access or amendment to information held by Council. You may also make a request that Council suppress your personal information from a public register. Council will consider any such application in accordance with the PPIPA.
Council is to be regarded as the agency that holds the information.
If you have any further enquiries concerning this matter contact Council’s Public Officer on 9843 0555.
