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RequestPlanningProposal.docx / Planning Reform/ Aug-13 Page 1 of 2
Request to Prepare a Planning Proposal
(OFFICE USE)
PP No File No Date Received
Account # Land No Property No
A1. Applicant
Surname/s Given
Name/s OR
Company/
Organisation
ABN
Postal Address
Telephone Mobile
Facsimile Email
A2. Landowner’s Consent
As the owner/s of the subject land, I/we give consent to the lodgement of this request and to an authorised officer of Council to enter the premises for the purposes of inspecting work relevant to this application.
Name/s ALL owners (please print) Company (if applicable) Signature/s ALL owners
A3. Land Description
Lot Number Section DP/NPP/SP
Unit/Street No Street
Suburb/Town
Instructions Print Clear Form
Request to Prepare a Planning Proposal
Page 2 of 2 RequestPlanningProposal.docx / Planning Reform / Aug-13
A4. Proposal Details
Name of Proposal
Proposal
(Brief Description)
A5. Checklist
Has the planning proposal checklist been completed? Yes No
A6. Declaration
We the undersigned declare that all the information in this request, checklist and attachments are true and correct
We the undersigned understand that if the information is incomplete the application may be delayed or rejected.
Applicants Name (please print)
Applicant’s Signature Date
Applicant’s Name (please print)
Applicant’s Signature Date
A7. Assignment of Copyright
To facilitate the intended purpose of the attached study, and avoid any potential breach of copyright in respect of the use of material provided, Tweed Shire Council requires the following copyright waiver to be completed.
I on behalf of
in accordance with the Copyright Act 1968 hereby assign all intellectual property for all project materials, works, subject matter, documents, or the like, prepared and presented as attached to this assignment notice, to Tweed Shire Council without cost, and royalty free.
Licensor's Name
(please print) Title
Licensor's Signature Date
Licensor's Name
(please print) Title
Licensor's Signature Date
