Application Form Certiﬁcate of Compliance 4
Please discuss your proposal with us if you require any further help with preparing your application.
The Council does provide pre-application meetings without charge to assist in understanding the issues
associated with your proposal and completing your application. This service is there to help you.
Please note that we are able to provide you with planning information but we cannot prepare the
application for you. You may need to discuss your application with an expert such as a planning
consultant, surveyor or lawyer, if you need further advice.
Gore District Council Planning Services staff can be contacted as follows:
In Writing: Gore District Council, PO Box 8, Gore 9740
In Person: Gore District Council, 29 Bowler Avenue, Gore,
but please phone ﬁrst to make an appointment.
By Phone: (03) 209 0330
By Email: email@example.com
There is also information on our website at www.goredc.govt.nz.
Completed and Signed Application Form
Description of Activity
Site Plan, Floor Plan and Elevations (where relevant)
Historic Copy of Certiﬁcate of Title (less than 3 months old) including any relevant restrictions
(such as consent notices, covenants, encumbrances, building line restrictions)
Application Fee (cash, cheque, Internet banking or EFTPOS only; no Credit Cards accepted)
Bank account details for refunds
Cash (do not post)
EFTPOS (at Gore District Council)
Cheques payable to: Gore District Council
Post cheques to: Gore District Council
PO Box 8, Gore 9740
Internet Banking Payments: Gore District Council
Account Number: 03-0915-0289519-00
Particulars: Please use your Name
Reference: Please use your Address
In order to ensure your application is not rejected or delayed through requests for further information,
please make sure you have included all of the necessary information.
I certify that, to the best of my knowledge and belief, the information given in this application is true and correct.
I accept that I have a legal obligation to comply with any conditions imposed on the Resource Consent should
this application be approved.
Subject to my/our rights under section 357B and 358 of the Resource Management Act 1991 to object to
any costs, I agree to pay all the fees and charges levied by the Gore District Council for processing this
application, including a further account if the cost of processing the application exceeds the deposit paid.
Signature of Applicant/Agent (delete one): Date: