APPLICANT //
CORRESPONDENCE DETAILS //
If you are acting on behalf of the applicant e.g. agent, consultant or architect
please ll in your details in this section.
*Applicant’s Full Name / Company / Trust:
(Name Certicate is to be issued in)
All trustee names (if applicable):
Contact Name if company or trust:
*Postal Address: *Post code:
*Contact details supplied must be for the applicant and not for an agent acting on their behalf and must include a valid postal address
*Email Address:
*Phone Numbers: Day Mobile:
*Name & Company:
*Phone Numbers: Day Mobile:
*Email Address:
*Postal Address: *Postcode:
Our preferred methods of corresponding with you are by email and phone.
The decision will be sent to the Correspondence Details by email unless requested otherwise.
The Applicant is:
Owner Prospective Purchaser (of the site to which the application relates)
Occupier Lessee Other - Please Specify
Must be a person or legal entity (limited liability company or trust).
Full names of all trustees required.
The applicant name(s) will be the consent holder(s) responsible for the consent and any associated costs.
INVOICING DETAILS //
Invoices will be made out to the applicant but can be sent to another party if paying on the applicants behalf.
For more information regarding payment please refer to the Fees Information section of this form.
*Attention:
*Postal Address: *Post code:
*Please provide an email AND full postal address.
*Email:
Applicant: Agent: Other, please specify:
Email: Post:
Please select a preference for who should receive any invoices and how they would like to receive them.
Page 1/4 // July 2018
EXISTING USE
CERTIFICATE
Under Section 139A Resource Management Act 1991
PLEASE COMPLETE ALL MANDATORY FIELDS* OF THIS FORM.
This form provides contact information and details of your application. If your form does not provide the required information it will be returned to
you to complete. Until we receive a completed form and payment of the initial fee, your application may not be accepted for processing.
APPLICATION FOR
OWNER DETAILS // Please supply owner details for the subject site/property if not already indicated above
DETAILS OF SITE // Legal description eld must list legal descriptions for all sites pertaining to the application.
Any elds stating ‘refer AEE’ will result in return of the form to be fully completed.
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)
District Plan Zone(s):
DETAILS OF SITE // Legal description eld must list legal descriptions for all sites pertaining to the application.
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)
District Plan Zone(s):
DESCRIPTION OF EXISTING ACTIVITIES:
This application is for an existing use certicate for the following activities:
PREAPPLICATION MEETING
Have you had a pre-application meeting with QLDC regarding this proposal?
Yes No Copy of minutes attached
If ‘yes’, provide the reference number and/or name of sta member involved:
SITE VISIT REQUIREMENTS //
Is there a gate or security system restricting access by council?
Is there a dog on the property?
Are there any other hazards or entry restrictions that council sta need to be aware of?
If ‘yes please provide information below
YES NO
YES NO
YES NO
SITE VISIT REQUIREMENTS // Should a Council officer need to undertake a site visit please answer the
questions below
Is there a gate or security system restricting access by council?
Is there a dog on the property?
Are there any other hazards or entry restrictions that council sta need to be aware of?
If ‘yes please provide information below
YES NO
YES NO
YES NO
Owner Name:
Owner Address:
If the property has recently changed ownership please indicate on what date (approximately) AND the names of the previous owners:
Date:
Names:
Page 2/4 // July 2018
INFORMATION REQUIRED TO BE SUBMITTED
To be accepted for processing, your application should include the following:
A completed, signed application form
Computer Freehold Register for the property (no more than 3 months old)
and copies of any consent notices and covenants
(Can be obtained from Land Information NZ at https://apps.linz.govt.nz/survey-titles/order-copy/).
Locality Plan or Aerial Photo, topographical features, buildings etc.
Plans
A document detailing:
A full description of the activity for which existing use rights are claimed.
Evidence that demonstrates the lawful establishment of the activity and, if relevant, that the activity has
continued to be lawful. This may include copies of archived district plans, building consents, correspondence,
photographs.
A full description of the character, intensity, and scale of the activity, and how these are the same or similar to
those at the time immediately before the activity most recently required a resource consent, that is, before the
current rule(s) became operative or the proposed plan was notied.
Conrmation that the use has been continuous since the time resource consent was required. If the use ceased for a
period, this needs to be identied and the period stated.
For uses of the surface of water in lakes and rivers related to operative rules in a district plan or uses related to
operative rules in a regional plan only, a statement conrming that a resource consent was applied for within
6 months of the plan becoming operative.
We prefer to receive applications electronically. Please ensure documents are scanned at a minimum resolution of 300 dpi.
Each document should be no greater than 10mb
PRIVACY INFORMATION
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.
FEES INFORMATION
Section 36 of the Resource Management Act 1991 deals with administrative charges and allows a local authority to levy
charges that relate to, but are not limited to, carrying out its functions in relation to receiving, processing and granting of
resource consents (including certicates of compliance and existing use certicates).
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 a resource consent application
are payable prior to issuing of the decision. Payment is due on the 20th of the month or prior to the issue date –
whichever is earlier.
Section 357B of the Resource Management Act provides a right of objection in respect of additional charges. An objection must be
in writing and must be lodged within 15 working days of notication of the decision.
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.
A list of Consent Charges is available on the on the Resource Consent Application Forms section of the QLDC website. If you are
unsure of the amount to pay,
please call 03 441 0499 and ask to speak to our duty planner.
Please ensure to reference any banking payments correctly. Incorrectly referenced payments may cause delays to the processing of
your application whilst payment is identied.
If the initial fee charged is insucient to cover the actual and reasonable costs of work undertaken on the application you will be
required to pay any additional amounts 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.
Page 3/4 // July 2018
PAYMENT // An initial fee must be paid prior to or at the time of the application and proof of payment submitted.
Please note processing will not begin until payment is received (or identied if incorrectly referenced).
I conrm payment by:
Bank transfer to account 02 0948 0002000 000 (If paying from overseas swiftcode is – 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 RM reference number)
*Reference
*Amount Paid
(For required initial fees refer to website for Resource Consent Charges or speak to the Duty Planner by phoning 03 441 0499)
*Date of Payment
Please reference your payments as follows:
Applications yet to be submitted: RM followed by rst 5 letters of applicant name e.g RMJONES
Applications already submitted: Please use the RM# reference that has been assigned to your application, this will have been
emailed to yourself or your agent.
Invoices are available on request
APPLICATION & DECLARATION
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 within 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 within the Fees Information section.
I hereby apply for the existing use certicate for the Proposal described above and I certify that, to the best of my
knowledge and belief, the information given in this application is complete and accurate.
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, warran-
ties and certication.
OR:
PLEASE TICK
Page 4/4 // July 2018
Please select
click to sign
signature
click to edit
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