Fillable Administration Form A (Hawkes Bay Regional Council New Zealand)

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Administration Form A (Hawkes Bay Regional Council New Zealand)

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  • 52 check-boxes
  • 71 other fields

Country of origin: NEW-ZEALAND
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Administration Form ‘A’
Please note: If your consent is notified additional deposits are required. We
will advise you if your application will be notified once assessed.
I
NSTRUCTIONS: PLEASE READ
1. An application must consist of an Administration Form ‘A’ and Form ‘B’ (Technical information relevant
to the type of activity being applied for).
2. Fill in all fields or write not applicable if appropriate.
3. If you have any questions please contact Council’s Consents Advisor on 06 833 8090, email:
ConsentAdvisor@hbrc.govt.nz
4. Maps, map references (easting & northings), legal descriptions and existing consent information can
be found using Councils online map portal at hbrc.govt.nz (bottom of home page, Find it on a map’
consents)
5. Your deposit must accompany your application. For payments via online banking or online credit card
please email the Consent Advisor with the applicant’s name (from section 1.4 of this form), postal
address and ask for a payment reference prior to lodging your application.
Account BNZ - 02 0700 030 2819 00
Please note, Council does not generally create invoices for application deposits, this front sheet has
been designed in lieu of an invoice, GST information is shown in the top box.
6. Ensure you have signed section 4.5 of this form and included/arranged for payment of the deposit
before submitting.
7. Submitting Applications: Post, email or deliver the application along with any other supporting
information and the required deposit to: Consent Advisor, Hawke’s Bay Regional Council, Private Bag
6006, NAPIER 4142. 159 Dalton Street, Napier or via email: ConsentAdvisor@hbrc.govt.nz
This application is for:
A New Consent
Deposit of $2,300.00
A Change to an Existing Consent
Deposit of $862.50
A Replacement of an Expiring Consent
Deposit of $2,300.00
Certificate of Compliance – Domestic Wastewater
Deposit of $287.50
DIN exceeding and under LUC - Tukituki
Deposit of $1,150.00
Certificate of Compliance – All Other Activities
Deposit of $1,725.00
All fixed deposits are Inclusive of GST (GST # 051 227 875)
Office Use
Previous Auth. __________________
NAV No. __________________
Charge No. __________________
APP No. __________________
AUTH No. __________________
Form A
Page 2 of 5
1 ADMINISTRATION DETAILS
1.1 If this is a Change or Replacement application, please provide the Consent/Auth number(s)
you are wishing to replace/change Or NA
__________
For Replacement Applications, do you agree that your application can be processed any
time before the current expiry date: Yes
*Please note that if consent is granted prior to the expiry date, you agree to your existing consent
being surrendered in favour of your new consent.
1.2 Number of Activities applied for: Single Activity Multiple Activities
1.3 Type of Activity(s) being applied for:
Bore Permit Water Permit Land Use Consent
Discharge Permit Discharge from on-site Waste Water Systems to land
Forestry or woodlot Other ________________________________
1.4 Applicant Details: Who will hold the Consent/ COC (The Applicant/s)?
Private Person(s) Go to Q 1.5
Company. Company Name ________________________________ Go to Q 1.6
Trust Partnership. Name _________________________________ Go to Q 1.5
Other. Name ____________________________________________ Go to Q 1.5
1.5 The full names (first, middle & last names) and contact details for all of the Private
Person(s)/Trustees/Partners/Others applying:
Applicant 1 _________________________________________________________
Postal Address _______________________________________________________
Cell Phone _____________________ Home/Work Phone ____________________
Email ______________________________________________________________
Applicant 2 (if applicable) ______________________________________________
Postal Address _______________________________________________________
Cell Phone _____________________ Home/Work Phone ____________________
Email ______________________________________________________________
Applicant 3 (if applicable) ______________________________________________
Postal Address _______________________________________________________
Cell Phone _____________________ Home/Work Phone ____________________
Email ______________________________________________________________
Applicant 4 (if applicable) ______________________________________________
Postal Address _______________________________________________________
Cell Phone _____________________ Home/Work Phone ____________________
Email ______________________________________________________________
Form A
Page 3 of 5
Applicant 5 (if applicable) ______________________________________________
Postal Address _______________________________________________________
Cell Phone _____________________ Home/Work Phone ____________________
Email ______________________________________________________________
NB* If more than five persons (applicants) please attach their details separately.
1.6 Main Contact Person
1.7 Applicant’s postal address
___________________________________ Bus/Home: ___________________
___________________________________ Mob: ________________________
___________________________________ E-mail: _______________________
Post Code: ____________ _____________________________
1.8 Agent. This is a consultant or other person handling the application on your behalf - leave
blank if not applicable.
Company/Name: _____________________ Main Contact person: ____________
Address: ____________________________ Bus/Home: ____________________
___________________________________ Mob: _________________________
___________________________________ E-mail: _______________________
1.9 Who is the final invoice/refund to be sent to? Agent The Applicant
1.10 Who would you like the application processing correspondence to be sent to?
Agent Main Applicant Contact
NB* If an email address is provided, this will be the default address for service of all documents.
1.11 Purchase Order. Please provide a purchase order number if you require it to be on your
invoice(s). __________________________
2 SITE OF ACTIVITY DETAILS
2.1 Property Owner’s Name & Address
Same as Applicant (skip to Q2.2) Bus/Home: ____________________
___________________________________ Mob: _________________________
___________________________________ E-mail: _______________________
Post Code: __________________________ _____________________________
2.2 Location of Activity(s) (the street address of the property)
___________________________________________________________________
___________________________________________________________________
2.3 Legal Description of site of proposed activity(s) (Lot and DP number)
___________________________________________________________________
___________________________________________________________________
Form A
Page 4 of 5
2.4 For water takes only: please provide the legal description(s) of the site of use (irrigation
area)
___________________________________________________________________
___________________________________________________________________
2.5 Map reference (NZTM Easting and Northing) ______________________________
2.6 Do you have any other existing resource consents on this property? Yes No
If yes, Consent/AUTH no(s). ____________________________________________
2.7 Please provide a site map clearly showing points where the activity will occur. (A Google
map or HBRC Map from hbrc.govt.nz is acceptable) Attached
2.8 Have you received any advice form HBRC prior to lodging this application? Yes
No
2.9 If yes, please confirm who you have received advice from and/ or list the pre-application
number if known:
_____________________________________________________________
2.10 Are other consents required to undertake the activities which this application is seeking
authorisation for (e.g. Building consent from TLA) Yes No
If Yes, Please detail ___________________________________________________
Applied for ref: ____________________________________ Or Yet to apply
3 PROPERTY OWNERSHIP
Is the Applicant the owner of all properties that this application applies to? Yes No
If yes, skip to Q4
If No, have you discussed the application with the property owner(s)? Yes No
Have the owner(s) given their approval for the application? Yes No
If yes, Please have the owners fill in the approvals section below:
To be completed by the Property Owner – only if different from applicant:
An application to undertake an activity on your property is being made. Please confirm
your approval for the activity to occur on your property by signing below. Please ensure
you have reviewed Forms A & B and/or any attached AEE document(s).
Signature of Property Owner: ______________________________________
Name: ___________________________________ Date: _____________
Please print full name of person who signed above.
Signing above constitutes provision of written approval and in accordance with s95E of the RMA
you will not be considered an affected party. Should you have any questions with regards to the
giving of approval for this application and the implications, please contact the Council’s Consents
Advisor on 06 833 8090.
Note: If the property owner has not signed above, or has not provided a separate written approval form,
they may be considered an affected party
.
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Form A
Page 5 of 5
4 GENERAL INFORMATION
4.1 Costs of Debt Recovery
It is agreed by the consent holder that it is a term of the granting of this resource consent that
all costs incurred by the Council for, and incidental to, the collection of any debt relating to this
resource consent, whether as an individual or as a member of a group, and charged under s36
of the Resource Management Act, shall be borne by the consent holder as a debt due to the
Council, and for that purpose the Council reserves the right to produce this document in support
of any claim for recovery.
4.2 Information held by Hawke’s Bay Regional Council
Please note that all information collected and held by the Hawke’s Bay Regional Council is
public information under section 2 of the Local Government Official Information and Meetings
Act 1987 (LGOIMA), as such any and all information may be requested by a third party. Access
to information held by Council is administered in accordance with LGOIMA and the Privacy Act
1993. If you have any concerns over the disclosure of any aspect of your consent or
personal/property details, either in person or electronically, you must raise your concern in
writing to The Council and detail what “good reason” you believe there is for withholding
information pursuant to section 7 of LGOIMA. Council will assess your request and advise you
of the decision made. Please note that no person has the right of veto over any information
held by Council. Council intends for all information it holds, submitted without a request for
nondisclosure (as above), to be public, and accessible to any persons who requests it pursuant
to LGOIMA. If you require more information on the situations that information may be provided,
please contact the Councils Consents Advisor.
4.3 Additional Information Required
You must also complete a relevant Form ’B’ – Assessment of Environmental Effects, and
attach to this Form A before submitting.
Please indicate the total number of additional documents attached to this application:
Relevant Form B: Required
Separate AEE document(s): or NA
Map(s): Required
Other: ______________________ or NA
4.4
Deposit
Method of payment: Eftpos/Cash
Online Credit Card Direct Deposit Cheque
Payment made
or Please email the applicant payment instructions
4.5
Applicants Signature
To be completed by the Applicant: Application is hereby made for the consent(s) detailed in both
forms A & B and any attached additional information in accordance with s88 of the RMA 1991. I/we
have read the disclaimers contained herein, understood and agree to the information provided in this
application. All information provided is true and correct.
Signature of applicant or authorised agent: ___________________________________
Name: ___________________________________ Date: ____________________
Please print full name of person who signed above.
Applications will not be processed until the required deposit is also received. Additional costs if
applicable will be charged when the final cost of processing is known.
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Administration Form A (Hawkes Bay Regional Council New Zealand)

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Completed 26 November 2020

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