
 
Clutha
District Council
 
 






P
ermit Fee aached 
 

 
  

Signature:


Date:
I
Definition:        
 
Note:             

 
               

Attached: Map/ Plan Photos (These must be attached for the permit to be considered)
Oice use only




I
APPROVED
I
NOT APPROVED
    
 

 
Y

N
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome