DETAILS OF SITE
*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)
Owners / Occupiers of the Site:
If different from applicant above
Our preferred methods of corresponding with you are by email and phone.
The decision will be sent to the Correspondence Details via email unless requested otherwise.
CORRESPONDENCE DETAILS // If different than above – E.g. consultant, agent or architect
Name & Company:
Phone Numbers: Day Mobile:
Email Address:
APPLICANT // Must be a person or legal entity (limited liability company or trust). Full names of all trustees required.
*Applicant’s Full Name / Company / Trust:
*All trustee names (if applicable):
*Contact Name:
*Postal Address: *Post code:
*Email Address:
*Phone Numbers: Day Mobile:
The Applicant is:
Owner Prospective Purchaser (of the site to which the application relates)
Occupier Lessee
Other - Please Specify
Page 1/6 // July 2017
APPLICATION FOR RESOURCE CONSENT
HERITAGE
TREE PRUNING
Under Section 88 of the Resource Management Act 1991 (Form 9)
Please complete all mandatory elds* 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 returne to
you to complete. Until we receive a completed form your application may not be accepted for processing.
BRIEF DESCRIPTION OF THE PROPOSAL
Consent is sought to prune a heritage tree as follows:
An arborist report has been completed by:
INFORMATION REQUIRED TO BE SUBMITTED //
Attach to this form any information required
(see below & appendix 1).
To be accepted for processing, your application for heritage tree pruning should include the following:
For all applications:
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/).
An aerial photo / plan showing the locality.
A plan / map or sketch the location of tree(s) on the site.
Photos of the subject tree(s).
An elevation view of any tree(s) to be pruned, identifying the location of the pruning work.
Written approval of every person who may be adversely affected by the granting of consent (s95E).
An Assessment of Effects (AEE).
An AEE is a written document outlining how the potential effects of the tree pruning have been considered,
including extent of pruning, timing of works, reasons for proposed pruning, who will be carrying out the works,
and can be addressed by the provision of an arborist report.
Arborist Report.
Notes: Arborist reports must be undertaken by Council approved Arboriculture Consultants and be
current members of the New Zealand Arboricultural Association
Fees are exempt if Council approved Arborists are used: NZ Tree Care and Asplundh
We prefer to receive applications electronically – see Appendix 2 - Naming of Documents Guide
Please ensure documents are scanned at a minimum resolution of 300 dpi.
Each document should be no greater than 10mb
CONSENT(S) APPLIED FOR
Land use consent to prune a heritage tree identied as protected feature #
PRE-APPLICATION MEETING OR URBAN DESIGN PANEL
Have you had a pre-application meeting with QLDC or attended the urban design panel regarding this proposal?
Yes No Copy of minutes attached
If ‘yes’, provide the reference number and/or name of staff member involved:
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 2/6 // July 2017
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 resource consent(s) 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, warranties and certication.
OR:
PLEASE TICK
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 company’s or the Council’s websites.
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 3/6 // July 2017
click to sign
signature
click to edit
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 4/6 // July 2017
APPENDIX 1 // RMA requirements for an application for Resource Consent
Section 2 of the District Plan provides additional information on the information that should be submitted with a land use or
subdivision consent.
The RMA (Fourth Schedule to the Act) requires the following:
1 INFORMATION MUST BE SPECIFIED IN SUFFICIENT DETAIL
Any information required by this schedule, including an assessment under clause 2(1)(f) or (g), must be specied
in sufcient detail to satisfy the purpose for which it is required.
2 INFORMATION REQUIRED IN ALL APPLICATIONS
(1) An application for a resource consent for an activity (the activity) must include the following:
(a) a description of the activity:
(b) a description of the site at which the activity is to occur:
(c) the full name and address of each owner or occupier of the site:
(d) a description of any other activities that are part of the proposal to
which the application relates:
(e) a description of any other resource consents required for the proposal
to which the application relates:
(f) an assessment of the activity against the matters set out in Part 2:
(g) an assessment of the activity against any relevant provisions of a
document referred to in section 104(1)(b).
(2) The assessment under subclause (1)(g) must include an assessment of the activity against—
(a) any relevant objectives, policies, or rules in a document; and
(b) any relevant requirements, conditions, or permissions in any
rules in a document; and
(c) any other relevant requirements in a document (for example,
in a national environmental standard or other regulations).
(3) An application must also include an assessment of the activity’s effects on the environment that—
(a) includes the information required by clause 6; and
(b) addresses the matters specied in clause 7; and
(c) includes such detail as corresponds with the scale and signicance
of the effects that the activity may have on the environment.
ADDITIONAL INFORMATION REQUIRED IN SOME APPLICATIONS
An application must also include any of the following that apply:
(a) if any permitted activity is part of the proposal to which the application relates, a description of the
permitted activity that demonstrates that it 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)):
(b) if the application is affected by section 124 or 165ZH(1)(c) (which relate to existing resource
consents), an assessment of the value of the investment of the existing consent holder (for the
purposes of section 104(2A)):
Information
provided
within the
Form above
Include in
an attached
Assessment
of Effects
(see Clauses
6 & 7 below)
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 5/6 // July 2017
ASSESSMENT OF ENVIRONMENTAL EFFECTS
Clause 6: Information required in assessment of environmental effects
(1) An assessment of the activity’s effects on the environment must include the following information:
(a) if it is likely that the activity will result in any signicant adverse effect on the environment,
a description of any possible alternative locations or methods for undertaking the activity:
(b) an assessment of the actual or potential effect on the environment of the activity:
(c) if the activity includes the use of hazardous substances and installations, an assessment of
any risks to the environment that are likely to arise from such use:
(d) if the activity includes the discharge of any contaminant, a description of—
(i) the nature of the discharge and the sensitivity of the receiving environment to
adverse effects; and
(ii) any possible alternative methods of discharge, including discharge into any
other receiving environment:
(e) a description of the mitigation measures (including safeguards and contingency plans where
relevant) to be undertaken to help prevent or reduce the actual or potential effect:
(f) identication of the persons affected by the activity, any consultation undertaken, and any
response to the views of any person consulted:
(g) if the scale and signicance of the activity’s effects are such that monitoring is required, a
description of how and by whom the effects will be monitored if the activity is approved:
(h) if the activity will, or is likely to, have adverse effects that are more than minor on the exercise
of a protected customary right, a description of possible alternative locations or methods for the
exercise of the activity (unless written approval for the activity is given by the protected customary
rights group).
(2) A requirement to include information in the assessment of environmental effects is subject to the provisions
of any policy statement or plan.
(3) To avoid doubt, subclause (1)(f) obliges an applicant to report as to the persons identied as being affected
by the proposal, but does not—
(a) oblige the applicant to consult any person; or
(b) create any ground for expecting that the applicant will consult any person.
CLAUSE 7: MATTERS THAT MUST BE ADDRESSED BY ASSESSMENT OF ENVIRONMENTAL EFFECTS
(1) An assessment of the activity’s effects on the environment must address the following matters:
(a) any effect on those in the neighbourhood and, where relevant, the wider community, including
any social, economic, or cultural effects:
(b) any physical effect on the locality, including any landscape and visual effects:
(c) any effect on ecosystems, including effects on plants or animals and any physical disturbance of
habitats in the vicinity:
(d) any effect on natural and physical resources having aesthetic, recreational, scientic, historical,
spiritual, or cultural value, or other special value, for present or future generations:
(e) any discharge of contaminants into the environment, including any unreasonable emission of
noise, and options for the treatment and disposal of contaminants:
(f) any risk to the neighbourhood, the wider community, or the environment through natural hazards
or the use of hazardous substances or hazardous installations.
(2) The requirement to address a matter in the assessment of environmental effects is subject to the provisions
of any policy statement or plan.
APPENDIX 2 // Naming of documents guide
While it is not essential that your documents are named the following, it would be helpful if you could title your documents
for us. You may have documents that do not t these names; therefore below is a guide of some of the documents we
receive for resource consents. Please use a generic name indicating the type of document.
Application Form 9
Assessment of Environmental Effects (AEE)
Computer Register (CFR)
Arborist Report
Affected Party Approval/s
Site Plan / Photos
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 6/6 // July 2017
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