Written Approval of Affected
Persons (Affected Party Consent Form)
APA01
VER 1.3
Nov 2016
P
ART A (to be completed by applicant)
Address of
proposed activity:
Consent number
if known:
Record of documents presented to the affected party:
Brief description of proposed activity:
Resource consent(s) being sought for (describe what is being applied for):
PART B - AFFECTED PERSON(S)
Applicant(s) name:
(please write all
names in full)
PART A - APPLICATION
PART B (to be completed by persons and/or organisations providing written approval)
Tick if
owner
Tick if
occupier
Full name: (in print)
Address of affected property:
Mobile:
Phone:
Full name: (in print)
Full name: (in print)
1
PART B - AFFECTED PERSON(S) (continued)
I have authority to sign on behalf of all the other: (tick one)
OWNER(S)
OCCUPIER(S)
of the property. Please provide documentation proving this authority.
Please note: the approval of all the legal owners and the occupiers of the affected property may be necessary.
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 at any time before the determination of the application, I/we may give notice in writing to
the Council that this approval is withdrawn.
Note: You should only sign below if you fully understand the proposal. If you require the resource consent process
to be explained you can contact the Customer Service Team at the Council who can provide you with information.
Signature(s):
Signature(s):
Signature(s):
Date:
Date:
Date:
Please tick this box if there are other owners or occupiers of the property who are not represented on this form
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
available to members of the public, including business organisations, community groups and the media. You have the right to
request 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 resource consent.
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.
4. If you change your mind after signing the form, you may withdraw your approval at any time before the hearing if there is one, or
otherwise before a decision is made on the application, by advising the Council in writing that your approval is withdrawn. Obviously, you
should let us know as soon as you can after you change your mind.
See also the Ministry for the Environment Website http://www.mfe.govt.nz/publications/rma/everyday-guide-rma-your-rights-affected-
person
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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click to sign
signature
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signature
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