APPLICANT // Must be a person or legal entity (limited liability company or trust). Full names of all trustees required.
The invoices will be sent to this address or email.
CORRESPONDENCE DETAILS // If dierent than above applicant details – E.g. consultant, agent or architect
Applicant’s full name:
Company / Trust:
Contact Person / All trustee names:
Address / Location to which this application relates:
Legal Description:
Can be found on the Computer Freehold Register or Rates Notice – e.g Lot x DPxxx (or valuation number)
Owners / Occupiers of the Site: If different from applicant above
Phone Numbers: Day Mobile:
Email Address:
Postal Address: Post code:
Name & Company:
Phone Numbers: Day Mobile:
Email Address:
Our preferred methods of corresponding with you are by email and phone.
The decision will be sent to the Correspondence Details via email.
Page 1/3 // July 2018
CONSENT NUMBER(S) - including variations
Attach to this form any information required
The information requirements detailed in the attached Checklist should be addressed.
We prefer to receive applications electronically
All applications to be lodged to
Please ensure documents are scanned at a minimum resolution of 300dpi.
Each document should be no greater than 10MB
The information you have provided on this form is required so that your application can be processed under the Resource
Management Act 1991 and may also be used in statistics collected and provided to the Ministry for the Environment and
Queenstown Lakes District Council. The information will be stored on a public register and may be made available to the
public on request or on the companys or the Council’s websites.
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
Page 2/3 // July 2018
PAYMENT // A deposit fee must be paid prior to or at the time of the application and proof of payment submitted.
I conrm payment by:
Bank transfer to account 02 0948 0002000 000 reference EA-RM# (eg EA-
RM170000)(If paying from overseas swiftcode – BKNZNZ22)
Cheque payable to Queenstown Lakes District Council attached
Manual Payment at reception (can only be accepted once application has been lodged and
acknowledgement email received with your unique EA reference number)
Fee Required: $412.50
The Council relies on the information contained in this application being complete and accurate. The Applicant must take all reasonable
steps to ensure that it is complete and accurate and accepts responsibility for information in this application being so.
If lodging this application as the Applicant:
I/we hereby represent and warrant that I am/we are aware of all of my/our obligations arising under
this application including, in particular but without limitation, my/our obligation to pay all fees and
administrative charges (including debt recovery and legal expenses) payable under this application as
referred to the Fees Information section.
If lodging this application as agent of the Applicant:
I/we hereby represent and warrant that I am/we are authorised to act as agent of the Applicant in
respect of the completion and lodging of this application and that the Applicant is aware of all of his/
her/its obligations arising under this application including, in particular but without limitation, his/her/
its obligation to pay all fees and administrative charges (including debt recovery and legal expenses)
payable under this application as referred to the Fees Information section.
Signed (by or as authorised agent of the Applicant) **
Full name of person lodging this form
Firm/Company Dated
**If this form is being completed on-line you will not be able, or required, to sign this form and the on-line lodgement will be treated as
conrmation of your acknowledgement and acceptance of the above responsibilities and liabilities and that you have made the above
representations, warranties and certication.
An initial fee for processing this application will be charged at the time of lodgement in accordance with QLDC’s fee
schedule. This initial fee must accompany your application for processing to commence. If the initial fee is insucient
to cover the actual and reasonable costs of work undertaken on the application you will be required to pay any additional
amount and will be invoiced monthly as work on the application continues. Please note that if the Applicant has outstanding
fees owing to Council in respect of other applications, Council may choose to apply the initial fee to any outstanding
balances in which case the initial fee for processing this application may be deemed not to have been paid.
Invoiced sums are payable by the 20th of the month after the work was undertaken. If unpaid, the processing of an
application, provision of a service, or performance of a function will be suspended until the sum is paid. You may also be
required to make an additional payment, or bring the account up to date, prior to milestones such as notication, setting a
hearing date or releasing the decision. In particular, all charges related to processing of an application are payable prior to
issuing of the approval. Payment is due on the 20th of the month or prior to the issue date – whichever is earlier.
LIABILITY FOR PAYMENT – Please note that by signing and lodging this application form you are acknowledging that the
Applicant is responsible for payment of invoices and in addition will be liable to pay all costs and expenses of debt recovery
and/or legal costs incurred by QLDC related to the enforcement of any debt.
Fees as per Resource Consent & Engineering Fees & Other Charges
Date of Payment
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
Page 3/3 // July 2018
P: 03 441 0499
click to sign
click to edit
Information Requirements for Application for Review and Acceptance
The following information is required for each application for Review and Acceptance. Please complete this form
and attach to the application and all applications shall be sent to
QLDC’s Land Development and Subdivision Code of Practice (LDS CoP) provides detailed guidance on the
information that shall be provided. The below schedule is a minimum requirement to be addressed by all
applications. Further information shall be supplied on request from QLDC. Please come to meet with us prior to
submitting your application to go through what you wil provide and we can confirm if requirements are met.
Information Requirements
Yes or No
Completed application form and associated fee
Cover letter identifying resource consent conditions for which engineering review
is requested and detailing how these conditions have been satisfied
Confirmation that all elements have been designed in accordance with QLDC’s
Land Development and Subdivision Code of Practice.
For elements that are not in accordance with QLDC’s Code of Practice or are an
alternative solution these shall be listed separately with a brief description of
each and why it is considered appropriate
Schedule 1A design certificate for each individual discipline
Design and construction documentation, including drawings, specifications
and calculations. All documents shall demonstrate they have passed through
an internal quality management system and been checked and approved by a
suitably qualified person, different from document author.
Copies of any expert hazard/geotechnical or traffic engineer’s assessments
completed and/or submitted in support of the original consent application and
explanation of how the report’s findings/recommendations have been addressed
as part of the detailed engineering design.
List of assets that are proposed to be vested with Council (these shall be shown
on a highlighted plan, it is acceptable for the highlighting to be undertaken by
Show compliance with the relevant resource conditions or where deviated from,
provide detailed explanations.
Identification of
special features
Stability assessment
Assessment of special soil types where applicable
Detail where specific engineering design is required i.e. retaining walls,
mechanically stabilized earth walls etc
Design and Access Statement (addressing all elements of section 3.3 of QLDC’s
LDS CoP) that
i. Road dimensions and layout;
ii. Link and place functions (as detailed in Table 3.2 of CoP);
iii. Connectivity of road network;
iv. How target operating speeds will be achieved (including description of
both physical and psychological devices and the individual effects these
will have);
v. How LID principles have been considered for stormwater run-off from
the roads;
vi. How cyclists will be provided for;
vii. How rubbish collection and associated turning areas will be provided.
Road Safety Audit vested roads and private accesses/parking areas
Information Requirements
Yes or No
Completed Road Safety Audit Exemption form if Road Safety Audit not required.
Occasionally if the roading design includes only very basic roading design and
intersections Council may agree to a Road Safety Audit exemption. Please discuss
with RM Engineering prior to considering this option.
Roading layout plan (to include landscape provisions) and pedestrian/cycle links
Internal access, manoeuvring & parking areas (including any pedestrian and cycle
links) associated with land use development
Cross sections including typical location of all services and separation (horizontal
and vertical)
Long sections
Sight distance plan
Structural design
Swept path analysis for intersection that are controlled (Stop or Giveway signs)
that includes 8m semi rigid truck
All Road markings and signage shown or state why road markings and signage
isn’t required or are not in compliance with MOTSAM
Standard details specific to the application
Stormwater Catchment Management Plan (prepared by the developer). If LID
devices are proposed, provide:
i. Evidence of QLDC involvement in the design process and written approval
from Council’s Asset Performance team that the proposed maintenance
requirements are acceptable to QLDC.
ii. Operation manuals (draft only with final copy provided at 224c)
Catchment Plan
Design Philosophy including allowance for upstream catchments and impact on
downstream catchments
Plans and long sections
Flood map for 1% AEP and 5% AEP storms (the 5% AEP plan should show no
flooding or ponding of water in roads, reserves and lots intended future
Overland Flow Paths Plan
Standard details
Catchment Plan
Design Philosophy (reticulation, pumping, treatment and disposal) including
allowance for adjacent catchments and impact on downstream catchments
Plans and long sections
Standard details
Proof of modelling undertaken and compliance with Council’s standards
Future development (to max extent defined by DP)
System design
System Layout
Confirmation of consultation with QLDC’s Parks Manager.
Landscaping layout, including all landscaping within road reserve and compliance
with QLDC Tree Planting guidelines
Irrigation plan that includes control, irrigation fittings and maintenance
Design parameters
Lighting layout and isolux plot lines plan
Compliance with the Southern Light Strategy
Information Requirements
Yes or No
All plans to be to scale (preferred scales are 1:100, 1:200 and 1:500)
All documents to be submitted as enabled PDF’s (searchable documents not
scanned copies, except for signature pages)
Council requires an integrated design approach to be taken and is under no obligation to issue
partial, provisional or staged design.
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