Application for permit to erect
I (name in full), ________________________________________________ hereby make
application to place electioneering signs on the sites listed on this form. I attach:
A plan showing the exact location of the each sign.
Details of the signs for each site. (Note that signs must not exceed 3 square metres in
size).
The written approval of the land owner. (Note that signs are not to be erected on
Council owned land or local road reserves.)
The written approval of NZ Transport Agency (NZTA) where the sign located on a
state highway.
My contact details are as follows:
Address: _________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Email: _________________________________________________________________
Phone
(daytime): ______________________ Cellphone: ______________________________
I understand and agree to comply with the provisions of the Gore District Council
Electioneering Signs Policy and with the requirements of Section 113 of the Local Electoral
Act 2001. Any sign not complying with those requirements can be removed by Council at my
expense.
Signature: ___________________________ Date: ________________________________
Note: Council staff will endeavour to process all applications with one week of lodging. No signs
shall be erected prior to receiving written approval of Council.
29 Bowler Avenue, Gore 9710
PO Box 8, Gore 9740
Phone 03 209 0330
Email info@goredc.govt.nz
www.goredc.govt.nz
Site 1
Location: ________________________________________
Owner’s Name: ________________________________________
-------------------------------------------------------------------------------------------------------------------------
For Office Use Only
Approved/Declined: ____________________
Date: ___________________ Sign No.: ________________
Site 2
Location: ________________________________________
Owner’s Name: ________________________________________
-------------------------------------------------------------------------------------------------------------------------
For Office Use Only
Approved/Declined: ____________________
Date: ___________________ Sign No.: ________________
Site 3
Location: ________________________________________
Owner’s Name: ________________________________________
--------------------------------------------------------------------------------------------------------------------------
For Office Use Only
Approved/Declined: ____________________
Date: ___________________ Sign No.: ________________
Site 4
Location: ________________________________________
Owner’s Name: ________________________________________
-------------------------------------------------------------------------------------------------------------------------
For Office Use Only
Approved/Declined: ____________________
Date: ___________________ Sign No.: ________________
Site 5
Location: ________________________________________
Owner’s Name: ________________________________________
-------------------------------------------------------------------------------------------------------------------------
For Office Use Only
Approved/Declined: ____________________
Date: ___________________ Sign No.: ________________
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