APPLICANT DETAILS
Hereby request the consent of the Queenstown Lakes District Council
to occupy Council land namely:
I/We (applicant):
Of (address):
On behalf of (insert name of body/company if applicable):
Company/Trust/Entity Name:
As the owners/occupiers of (insert address location, legal description etc):
Signed: Date:
Phone Numbers: Work: Home: Mobile:
Email Address:
Signed for QLDC: Date:
Name of Reserve:
Type of Activity:
Start Date: Duration:
SIGNATURE
I/We attach the following:
Application form and fee of $600.00
Plans of the proposal
(plans must be to scale)
Location Map showing site of proposal
and Council land affected
Plans must clearly show measurements
concerned with the proposal
Photographs of the site (where relevant)
Page 1/1 // July 2016
LICENCE TO
OCCUPY ROAD RESERVE
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
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