Form 9 Application for Resource Consent
(Section 88, Resource Management Act 1991)
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Planning Department
Horowhenua District Council
126 Oxford Street
Private Bag 4002
LEVIN 5540
Please Note
The initial fee payment is a deposit only. There will be additional charges for actual staff time spent processing
your application, which will be invoiced at the completion of the application. This is based on an hourly rate set in
the schedule of Planning Fees and Charges.
For subdivision applications it is strongly recommended that you complete the Applicant's Information Checklist to
ensure all information has been provided.
Completing this form
This form provides us with your contact details, and details about your proposed activity and its actual and potential
effects on the environment. Note that all the information provided in your application is available to the public.
We recommend that you talk your proposal through with Council staff before you fill in this form and when you lodge
your application. You should also contact us if you are unsure which forms you should be using, or if you need help
with filling in any of the forms.
I/We (Full name/s of Applicant(s):
apply for the following type/s of Resource Consent
Land Use Consent Subdivision Consent
Describe the activity which you are applying for and how it does/does not comply with the rules in the District
Plan (continue on a separate sheet if necessary):
Are there any names and addresses of the owner and occupier (other than the applicant), of any land to which
the application relates?
Yes No
If Yes, provide details below (continue on a separate sheet if necessary):
Owner/Occupier's Name 1:
Owner/Occupier's Address 1:
Owner/Occupier's Name 2:
Owner/Occupier's Address 2:
The site at which the proposed activity is to occur is as follows:
Street/Road Address:
Legal Description
Lot: DP CT Area (hectares/square metres)
Describe the location as it is commonly known and in a way that will enable it to be easily identified (e.g. the
street address, the legal description, the name of any relevant stream, river or other water body to which the
application relates, proximity to any well known landmark:
5. NATIONAL ENVIRONMENTAL STANDARDS (NES): Managing Contaminants in Soils
Is the activity covered by the above NES?
Yes No
If Yes, does the piece of land have, or has it had, an activity or industry described in the HAIL* undertaken on it:
*Please contact a staff member if you are unsure, or wish to see a list of HAIL activities.
If No, NES does not apply.
6. Select the statement that applies:
There are no other activities that are part of the proposal to which this application relates
The other activities that are part of the proposal to which the application relates are as follows:
Please describe:
Describe the other activities that are part of the proposal to which the application relates. For any activities that are
permitted activities, explain how the activity complies with the requirements, conditions, and permissions for the
permitted activity so that a resource consent is not required for that activity under section 87A(1) of the Resource
Management Act 1991.
Are there any additional Resource Consents needed for the proposed activity?
Yes No
If Yes, please supply details of the additional consents needed for the proposed activity and have/have not
been applied for
8. Assessment of Environmental Effects
* Please see the guide at the end of this form detailing what should be contained in an Assessment of
Environmental mEffects (AEE)
Generally the larger or more complex the proposal and effects, the more detailed this assessment should
be; for minor proposals use the space below.
I attach an assessment of the proposed activity's effect on the environment that:
(a) includes the information required by clause 6 of Schedule 4 of the Resource Management Act 1991
(b) addresses the matters specified in clause 7 of Schedule 4 of the Resource Management Act 1991
(c) includes such details as corresponds with the scale and significance of the effects that the activity
may have on the environment
Please give details:
I attach an assessment of the proposed activity against the matters set out in Part 2 of the Resource
Management Act 1991.
I attach an assessment of the proposed activity against any relevant provisions of a document referred to in
section 104(1)(b) of the Resource Management Act 1991, including the information required by clause 2(2) of
Schedule 4 of that Act
*As this is an application for a subdivision consent, I attach information that is sufficient to adequately define:
(a) the position of all new boundaries
#(b) the areas of all new allotments
(c) the locations and areas of new reserves to be created, including any esplanade reserves and
esplanade strips
(d) the locations and areas of any existing esplanade reserves, esplanade strips, and access strips
(e) the locations and areas of any parts of the bed of a river or lake to be vested in the territorial
authority under Section 237A of the Resource Management Act 1991
(f) the locations and areas of any land within the coastal marine area (which is to become part of the
common marine and coastal area under section 237 A of the Resource Management Act 1991
(g) the locations and areas of land to be set aside as new roads.
*Ignore if this is not an application for a subdivision consent.
#Ignore if the subdivision involves a cross-lease, company lease, or unit plan.
I attach the following further information required to be included in this application by the District Plan, the
Regional Plan, the Resource Management Act 1991, or any regulations made under that Act. (List all further
documents that you are attaching)
I/We have consulted and obtained the written approval of the following persons adversely affected by the
I do not consider any person as being adversely affected for the following reasons:
Yes No
(a) Site Plan (showing property boundaries, all existing/proposed buildings,
vehicle access etc)
(b) Floor Plans/Elevations (if applicable)
(c) Photograph (where necessary)
(d) Building Inspection report (for relocates)
(e) Certificate of Title (including all encumbrances, consent notices, easements,
covenants etc)
(f) Application Fee
(g) Applicant's Information Checklist (for subdivision applications only)
(h) Assessment of Environmental Effects (if applicable)
(i) Signed Written Approval Forms
If you have signed Written Approval Forms, please indicate the number of forms attached:
In order to ensure your application is not rejected or delayed through requests for further information, please make
sure you have included all of the necessary information. A full list of the information required for Resource Consent
Application is in the General Provisions section of the District Plan (Section 28) and Council's "Subdivision and
Development Principles and Requirements Version November 2012".
(if applicable)
* Name & Address: Name & Address:
Phone: Phone:
Mobile: Mobile:
Email: Email
Address for Service (if different from above) * Name and Address Application will be invoiced to:
You may apply for two (2) or more Resource Consents that are needed for the same activity on the same form. You
must pay the fee (fixed charge) payable to the consent authority for the resource consent application under the
Resource Management Act 1991.
The costs associated with this application can be found on Council's Fees and Charges
Payment can be made by cheque, EFTPOS or cash.
It is recommended that payment is made electronically using internet banking. Council’s Bank details are:
Horowhenua District Council
Account Number:
Ensure you include your name (e.g. AB SMITH) and the reason for payment (e.g. RESOURCE CONSENT) in the
Particulars and Reference sections when making payment. No action will be taken on your application until payment
has been receipted by Council and matched to your application. To speed things up send evidence of your payment
with your application email.
Please note: On receipt of an application, Council will determine whether the application needs to be notified and
will then advise you of the required notification fee. No application will be processed until Council is satisfied that all
information needed to assess the application is received, together with the necessary fee.
Should it be necessary for Council to refund part or all of the fee paid, please provide below the details of the bank
account you wish this to be paid to.
Account Name Bank Account Number
Signature of Applicant or person authorised to sign on behalf of Applicant
By typing your name in the space provided below, you are 'electronically signing' this form
Name: Date:
HDC is committed to being environmentally sustainable, therefore please submit your application
electronically to:
If you require further information please contact a member of our Customer Experience team on:
06 366 0999
Assessment of Environmental Effects (AEE)
An AEE is an essential part of the application. If an AEE is not provided the application will be considered
incomplete and will not be accepted for processing. The AEE should discuss all the actual and potential effects on
the environment arising from the proposal. The amount of detail provided must reflect the nature and scale of the
effects. For example, if there are major effects arising from the proposal, a detailed analysis and discussion of these
effects should be included in the AEE. It may require the provision of information from specific experts such as an
acoustic consultant or traffic engineer. If the effects of the proposal are very minor then a less detailed AEE can be
For more information see the Fourth Schedule of the Resource Management Act 1991 which lists the matters to be
covered in an AEE.
Please refer to the assessment criteria contained within the Horowhenua District Plan that are specific to the type of
application you applying for. These will help focus you on the types of effects that need to be addressed in your
assessment. These criteria are identified in Section 25 of the Plan and are specific to both subdivision and land use
Key questions that should be addressed in an AEE
Is this proposal likely to have any negative effects beyond the boundary of the site (for example, shading from a
building that can comply with height requirements)?
Can such a negative effect be avoided, remedied or mitigated (for example, significant trees growing on the
boundary of the potentially shaded property which will more than eclipse potential shading from the proposed
Is the proposal likely to have any positive effects (for example, a potentially dangerous vehicle crossing will be
closed and moved to a safer location)?
If you have trouble compiling the information, or need some advice on aspects of your application, please consult
Council’s Duty Planner - a planner is always available to assist with planning enquiries to provide assistance.
Further information relative to an AEE for both subdivision and land use applications is contained in Section 28 of
the District Plan and Council's "Subdivision and Development Principles and Requirements 2012".