Fillable Application for a permit to operate an amusement (Tararua District Council New Zealand)

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Application for a permit to operate an amusement (Tararua District Council New Zealand)

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The Application for a permit to operate an amusement (Tararua District Council New Zealand) form is 1 page long and contains:

  • 1 signature
  • 1 check-box
  • 30 other fields

Country of origin: NEW-ZEALAND
File type: PDF

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Application for a permit to operate an
amusement device
Please read this first
This form will be scanned by electronic equipment. It is important that you:
• use a blue or black pen to complete this form; and
• print clearly.
Office use only
Date received
/ / 2 0
tararua district council
•
26 gordon street
•
po box 115
•
dannevirke 4942
•
06 374 4080
•
info@tararuadc.govt.nz
Amusement Devices Regulations 1978
Applicant details (Please print in CAPITALS)
Name of applicant
Name of business
Address of applicant Postcode
0
-
0
-
Phone number Mobile phone number
Email
Device details
Certificate of Registration number(s)
Address of operation
/ /
2 0
to / /
2 0
Date(s) of operation
Full Certificate of Registration for each amusement device is attached.
Signature
I/We certify that having regard to the situation in which the device(s) is/are erected, it can be operated without danger to persons
operating it, using it or in the vicinity. The full Certificate of Registration is attached to this application.
/ /
2 0
Signature of applicant Date
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Application for a permit to operate an amusement (Tararua District Council New Zealand)

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Completed 11 February 2021

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