Private Bag 9023 | Whangarei 0148 | New Zealand
T: 09 430 4200 | 0800 WDC INFO | 0800 932 463 | F: 09 438 7632
W: www.wdc.govt.nz | E: mailroom@wdc.govt.nz
06/335936 September 2010
Notification of intention to register new premises under the Health Act
1956
Applicant’s full name
Postal address
Trading name of business
Business phone
Street address of premises
Type of premises (tick box
)
Food Camping ground Hairdressing Offensive trade
For food premises (please complete) Describe type (i.e. takeaway, restaurant, etc)
When dining is available on the premises, state the normal seating capacity
Will food be manufactured or sold from the premises other than by retail Yes No
For camping ground (please complete) State number of sites
For offensive trade (please complete) Describe type of trade
Signature
Date
Notes to applicant
No fees are paid with this form
Please return this form to Whangarei District Council, Private Bag 9023, Whangarei 0148
Attn: Support Assistant, Environmental Health
Office use
Licence expiry month
Licence number
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