Section 68 Activity Application Form - Bland Shire Council

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PO Box 21,
BLAND SHIRE COUNCIL
West Wyalong
SECTION 68 ACTIVITY
Ph: 6972 2266
Fax: 6972 2145
APPLICATION FORM
Email:
council@blandshire.nsw.gov.au
LOCAL GOVERNMENT ACT
Please attach all the plans and supporting information required to this form.
APPLICATION NUMBER –OFFICE
SECTION A
(to be completed in full)
USE ONLY
► GENERAL INFORMATION
S68
• GENERAL INFORMATION
APPLICANT'S DETAILS
DA/CC
Title (Mr, Mrs, Ms, Miss, Dr, Etc): _________
Full Name/Company Name: _____________
TYPE OF APPROVAL YOU
____________________________________
REQUIRE
Postal Address: _______________________
____________________________________
 Roads Act Approvals
(Section B)
Daytime Contact Details:
 Sewerage work
Phone: _______________________
(Section C)
Mobile: _______________________
Email: ______________________________
 Install and operate an on-site sewage
Fax:
________________________
management system
(Section D)
Signature: __________________________
__________________________
 Discharge trade waste into Council's
sewer
(Section E)
WHAT PROPERTY IS THE SUBJECT OF
 Install a solid fuel heater
THIS APPLICATION?
(Section F)
Street Address: ______________________
 Theatrical, musical or other
___________________________________
entertainment for the public on
community land
Locality: ____________________________
(Section G)
Lot, Section, DP/SP: __________________
 Construct a temporary enclosure on
___________________________________
community land for the purpose of
entertainment
ACTIVITY DESCRIPTION
(Section G)
Briefly describe everything you want Council
to approve:
 Other: ________________________
_____________________________________
_____________________________________
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