YOUR DETAILS // Our preferred methods of corresponding with you are by email and phone.
This is a submission on a notice of requirement from (name of territorial or other local authority,
Minister, requiring authority, or heritage protection authority who gave notice of requirement)
TO // Queenstown Lakes District Council
APPLICANT DETAILS //
Name:
Phone Numbers: Work: Home: Mobile:
Email Address:
Postal Address: Post code:
Applicant’s Name:
Application Reference Number:
Details of Application:
Location of Application:
The specic parts of the notice of requirement that my submission relates to are: (give details)
YOUR SUBMISSION
Page 1/3 // October 2017
FORM 21: SUBMISSION
ON REQUIREMENT FOR DESIGNATION
OR ALTERATION OF DESIGNATION
Resource Management Act 1991, Sections 168A, 169, 181, 189A, 190 and 195A
SUBMISSION
SIGNATURE
Signature (to be signed for or on behalf of submitter) **
Date
** If this form is being completed on-line you may not be able, or required, to sign this form.
My Submission is (include whether you support or oppose the specic parts of the notice of requirement or wish to have
them amended; and reasons for your views):
I seek the following recommendation or decision from the territorial authority: (give precise details, including the general
nature of any conditions sought)
I Support / Oppose the application
I Do / Do not wish to be heard in support of my submission
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: rcsubmission@qldc.govt.nz
www.qldc.govt.nz
Page 2/3 // October 2017
click to sign
signature
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APPENDIX A // Note to Submitter
If your submission relates to a notice of requirement for a designation or an alteration to a designation, and you are a
trade competitor of the requiring authority, you may make a submission only if you are directly aected by an eect of
the activity to which the requirement relates that—
(a) adversely aects the environment; and
(b) does not relate to trade competition or the eects of trade competition.
You must serve a copy of your submission on the person who gave the notice of requirement as soon as reasonably
practicable after you have served your submission on the territorial authority (unless the territorial authority itself gave
the notice of requirement).
Please note that your submission (or part of your submission) may be struck out if the authority is satised that at
least 1 of the following applies to the submission (or part of the submission):
it is frivolous or vexatious:
it discloses no reasonable or relevant case:
it would be an abuse of the hearing process to allow the submission (or the part) to be taken further:
it contains oensive language:
it is supported only by material that purports to be independent expert evidence, but has been prepared by a person
who is not independent or who does not have sucient specialised knowledge or skill to give expert advice on the
matter.
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: rcsubmission@qldc.govt.nz
www.qldc.govt.nz
Page 3/3 // October 2017
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