APEX01
VER 1.1
Nov17
Written Approval of Affected Persons
(PERMITTED BOUNDARY ACTIVITY)
PART A (to be completed by applicant)
Address of
proposed activity:
Application
number if known:
Record of documents presented to the affected party:
Brief description of proposed activity:
PART B - AFFECTED PERSON(S)
Applicant(s) name:
(please write all
names in full)
PART A - APPLICATION
PART B (to be completed by the owner of an affected property)
Full name: (in print)
Address of affected property:
Mobile:
Phone:
Full name: (in print)
Full name: (in print)
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PART C - DECLARATION
PART C (to be completed by persons and/or organisations providing written approval)
I/We have been given details of the proposal and plans to which I/we are giving written approval.
I/We have signed each page of the plans in respect of this proposal. These need to accompany this form.
I/We understand that by giving my/our written approval, the Council when considering the application cannot take
account of any actual or potential effects of the activity on my/our property.
Further, I/we understand that I/we cannot withdraw this affected party approval once provided.
Note: You should only sign below if you fully understand the proposal. If you require the resource consent
exemption process to be explained you can contact info@adc.govt.nz.
Signature(s):
Signature(s):
Signature(s):
Date:
Date:
Date:
Please tick this box to confirm that you have the authority to sign of behalf of all owners of the affected property.
PRIVACY INFORMATION
The information on this form is required to be provided under the Resource Management Act so that the application referred
to can be processed. Under this Act this information, together with associated reports and attachments, can be made avail-
able to members of the public, including business organisations, community groups and the media. You have the right to re-
quest access to personal information held about you by the Council, and you can request that it be corrected.
If you are asked to give your written approval and sign this form, you should do these things first:
1. Request that the applicant (or their representative) explain the proposal to you, including why it needs approval as a permitted
boundary activity.
2. Read all of the information provided so that you can understand the effects of the proposal. You can ask for more time to consider
the documents if you think you need it. If there are no plans available at this stage, we suggest you wait until you can look at them before
making any decisions.
3. Decide whether you are comfortable with the proposal. The following options are available to you:
a) If you are satisfied with the proposal and/or the effects are acceptable to you, you may decide to sign this form and a copy of the
associated documents.
b) You are entitled to ask the applicant for more information if you are not satisfied and you can also suggest changes if they would make
you more comfortable with the project although the developer might not agree to them. If you do reach agreement, you should sign only the
amended version of the proposal and all of the plans etc.
c) If you are willing to sign subject to a matter which is not part of the application and the developer also agrees, this will need to be the
subject of a separate agreement between yourselves which the Council will not be involved in. You might want to speak to your lawyer about
how to do this and at what point you should sign this form.
If you consider that you will be adversely affected by the proposal and/or do not wish to sign the approval form for any reason,
there is no obligation to do so and no reasons need to be given.
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