Permit to Erect Memorials
Application Form
Please return this form to: info@adc.govt.nz or Ashburton District Council, PO Box 94, Ashburton 7740
Applicant Details
Name:
Address:
Contact Number:
Memorial Requirements
Name of Cemetery:
Block:
Plot:
Memorial to:
Please provide the following information with your application:
Plan of the proposed memorial
Description of the memorial
Signature and Date
I hereby make an application for a Permit to Erect Memorials for the location above in accordance with Ashburton
District Council Bylaw 1999 as stated below:
Concrete based work for all memorials shall not stand higher than 500mm above the highest point of the
concrete beam or ground level, whichever is higher, and shall, where required, allow insets for flower
containers
On surface berms or platforms a space of 50mm clear of such memorial foundation base shall be
maintained, both front and back
No erected memorial shall, at the head of any plot be higher than 1.50m from the centre point of the beam.
Such memorial shall be acceptable to the Council and will comply with the appropriate New Zealand
Standard
No erected memorial shall be of any other material other than granite or concrete finished in grey or white
cement only or other material approved by Council
Signed: _____________________________ Date: _________________________________
click to sign
signature
click to edit
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