Application For Monumental Work In Council Cemeteries Form
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1
2Application for Monumental Work
in Council Cemeteries
If you wish to email this form to us please scan to PDF and send to cemeteries@codc.govt.nz.
No work can be undertaken until Council has approved the work and advised the applicant the work
may commence.
In accordance with New Zealand Standard Headstone and Cemetery Monuments: NZS 4242:1995.
Note: At Council's discretion a suitably qualified tradesperson may be granted permission to undertake the
work, however all contractors working on Council property must be registered with Site Wise and have the
required Health and Safety practices.
Permission to carry out monumental work in the following Cemetery: Please tick
Cromwell
Naseby
Ranfurly
Clyde
Alexandra
St Bathans
Nevis
Blacks (Omakau)
The following Cemeteries have a closed status so permissible work is limited in these cemeteries
Manuherikia
Hamiltons
Litany St (Cromwell)
Name of plot owner or legal representative: ____________________________________________________
Contact details: __________________________________________________________________________
Address: _______________________________________________________________________________
Email: _____________________________________________ Phone number: ______________________
Name of person/s in the plot: _______________________________________________________________
Description of plot location eg plot, block, row, section: ___________________________________________
______________________________________________________________________________________
Date of interment: ____________________________ Date of death: _______________________________
Description of work: Please tick
Erect footing
Erect headstone
Install ash plinth
Install ash plaque
Install plaque on footing
Remove ash plaque and
reinstate
Remove headstone for new
Restoration/repair damaged
inscription, then reinstate
headstones
Description of work: ______________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Date work to be completed by: ______________________________________________________________
Application for Monumental Work in Council Cemeteries
Created 03/15
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