Existing Use Certificate
Certificate of Compliance
Application Form
Section 139, Resource Management Act 1991
PCOC01
VER. 1.01
Jul2013
Send or deliver your application to: Planning Department, Ashburton District Council, 5 Baring Square
West, PO Box 94, Ashburton 7740.
For enquiries phone (03) 3077700, e-mail info@adc.govt.nz or visit the counter at Ashburton District
Council, 5 Baring Square West, Ashburton.
ABOUT THIS FORM
This form is an application form to request confirmation that a use or development does not
require Resource Consent from Ashburton District Council. A Certificate of Compliance is a
certificate that may be issued by the Council to certify, pursuant to s 139 of the Resource
Management Act 1991.
If you have any queries about these forms or why they are required, please contact the Planning
Department of the Ashburton District Council, ph: (03) 307 7700.
Part A - DETAILS
Applicant details (in whose name the consent is to be issued)
Name and address
Phone (wk) (home) Fax
Address for service (if different from above)
Name
Phone (wk) (home) fax
Site information (if different from above)
Location of property
Occupier’s name
Legal Description
Valuation ref.
(both the legal description and valuation number are shown on your rates demand)
Description of use
Describe in detail the activities to which this application relates i.e. what are you are applying for?
Address
Name and address of the owner of the property
Why do you think the use is permitted
In order for the Council to grant a certificate of compliance, evidence must be provided to confirm
that what is proposed is permitted and the reasons why a resource consent is not required.
Please note: In an application for a a cerficate of compliance, the onus is on the applicant to
supply sufficient evidence to prove that the use has been lawfully established. If sufficient
information is not provided, we may ask you for more information or your application might be
refused.
Please use a seperate sheet if needed.
Is the subject site contaminated? ie, is there any known evidence of physical, anecdotal
evidence to suggest that there may be contamination on the site? yes no
If yes please clarify how you comply with the National environmental standard for assessing and
managing contaminants in soil.
Part B - PRIVACY ACT 1993
The personal information requested in this form is being collected by the Planning Department of the
Ashburton District Council so that we can process your application. This information is required by the
Resource Management Act 1991 and will be held by the Council. You may ask to check or correct any
of the personal information if you wish.
The personal information collected will not be shared with any departments of the Council not
involved in processing your application. However under the Official Information and Meetings Act
1987 this information may be made available on request to parties within and outside the Council
Part C - SIGNATURE AND FEE
Signature of applicant or person authorised to sign on behalf of applicant
Signed Date
Name
I/We enclose a deposit of $ for the processing of this application.
Part D - OFFICE USE ONLY
Received in the planning office on (date) ………………………………………………...
by (name) ……………………………………………………………..
Amount paid $……………………………………………………
paid on (date) ……………………………………………………………………
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome