Fillable FORM 5: SUBMISSION: TO // Queenstown Lakes District (Queenstown Lakes District Council New Zealand)

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FORM 5: SUBMISSION: TO // Queenstown Lakes District (Queenstown Lakes District Council New Zealand)

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TO // Queenstown Lakes District Council
Name of submitter [full name]
[give details]
This is a submission on the following proposed policy statement (or on the following proposed plan or on a change proposed to the following policy
statement or plan or on the following proposed variation to a proposed policy statement or on the following proposed variation to a proposed plan or on the
following proposed variation to a change to an existing policy statement or plan) (the proposal):
I could / could not** gain an advantage in trade competition through this submission.
*I am / am not** directly affected by an effect of the subject matter of the submission:
(a) adversely affects the environment; and
(b) does not relate to trade competition or the effects of trade competition.
NAME OF // Proposed or existing policy statement or plan and (where applicable) change or variation
* Delete entire paragraph if you could not gain an advantage in trade competition through this submission.
** Select one.
SPECIFIC PROVISIONS // Of the proposal that my submission relates to are:
MY SUBMISSION
[Include: whether you support or oppose the specic provisions or wish to have them amended; and reasons for your view]
*If your submission relates to a proposed policy statement or plan prepared or changed using the collaborative planning process, you must indicate the following:
> whether you consider that the proposed plan or policy statement or change fails to give effect to a consensus position and therefore how it should be
modied; or
> in the case that your submission addresses a point on which the collaborative group did not reach a consensus position, how that provision in the plan or
policy statement should be modied.
* This paragraph may be deleted if the proposal is not subject to a collaborative planning process.
Page 1/2 // October 2019
FORM 5: SUBMISSION
ON NOTIFIED PROPOSED DISTRICT PLAN OR PLAN
CHANGE OR VARIATION OR POLICY STATEMENT
Clause 6 of Schedule 1, Resource Management Act 1991
*I wish / do not wish** to be heard in support of my submission.
I will / will not** consider presenting a joint case with others presenting similar submissions.
* In the case of a submission made on a proposed planning instrument that is subject to a streamlined planning process, you need only
indicate whether you wish to be heard if the direction species that a hearing will be held.
** Select one.
I SEEK THE FOLLOWING DECISION // From the local authority
[give precise details]
YOUR DETAILS // Our preferred methods of corresponding with you are by email and phone.
Electronic address for service of submitter [email]
Telephone [work] [home] [mobile]
Postal Address Post code
[or alternative method of service
under section 352 of the Act]
Contact person [name and designation, if applicable]
SIGNATURE
**Signature
[or person authorised to sign on behalf of submitter]
Date
** A signature is not required if you make your submission by electronic means.
NOTE // To person making submission
If you are a person who could gain an advantage in trade competition through the submission, your right to make a submission may be limited by clause 6(4)
of Part 1 of Schedule 1 of the Resource Management Act 1991.
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 offensive 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 suf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: services@qldc.govt.nz
www.qldc.govt.nz
Page 2/2 // October 2019
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FORM 5: SUBMISSION: TO Queenstown Lakes District (Queenstown Lakes District Council New Zealand)

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Completed 11 February 2021

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