APPROVAL OF AFFECTED PERSONS
A
B
C
D
Name (PRINT)
Contact Phone / Email address
Signature Date
Name (PRINT)
Contact Phone / Email address
Signature Date
Name (PRINT)
Contact Phone / Email address
Signature Date
Name (PRINT)
Contact Phone / Email address
Signature Date
The written consent of all owners / occupiers who are aected. If the site that is aected is jointly owned, the written consent of all
co-owners (names detailed on the title for the site) are required.
Note to person signing written approval
Conditional written approvals cannot be accepted.
There is no obligation to sign this form, and no reasons need to be given.
If this form is not signed, the application may be notied with an opportunity for submissions.
If signing on behalf of a trust or company, please provide additional written evidence that you have signing authority.
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: resourceconsent@qldc.govt.nz
www.qldc.govt.nz
Page 2/2 // October 2017
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