#47605
Application for Certificate
Sale & Supply of Alcohol Act 2012
Resource Management Act 1991 / Building Act 2004
I hereby apply for a Planning / Building Act compliance certificate which I require for
my liquor licence application for the premises described below:
Brief description of proposal (include detail of licence type, hours, days and attach plans if
available):
Address of the proposed licenced premises:
Legal description of the site of the premises:
Name of the owner of the premises:
Type of liquor licence applied for (i.e. On, Off, Club):
Note: The applicant is the person / club / company / organisation receiving the profits from the sale of alcohol. Please state
the full legal name of entity or person applying.
Signature (or name if providing electronically):
Please make payment at the time of lodgement to the following bank account:
Timaru District Council Amount: $290.00
02 0888 0269159 00 Reference: RMA LIQ
Particulars: Premise name