Approved, date: Declined Hold
Conditions to be imposed:
Yes (please list overleaf) No
Category classification
OT
FD
(please tick 3):
CG HD
Inspection months (please tick 3):
Jan Feb Mar April May June
July Aug Sept Oct Nov Dec
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Please return your application to the
local council where your business
resides. Address details overleaf.
CC to Trade Waste Officer:
Yes, date: No
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APPL ICATION FORM
REGISTRATION
OF P R E MISE S
BUSINESS DETAILS New business Yes No
Full name of applicant(s) or company name:
Trading name:
Address of premises: Postal address (if different):
Telephone: Mobile:
Fax: Email:
General purpose of premises (please complete further details on page 2):
Managers name
Proposed opening date Number of staff Max occupancy
scale (1:50) floor plan attached of the proposed premises, detailing all floor, wall and ceiling
surfaces and essential features referred to in the application procedures
Total fee payable $
Date
Signature of applicant or agent of business/ company:
oFFiCE usE onlY:
Medical Officer of Health approval required? Yes No
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(for hairdressers & campground)
Wash
hand basin
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DISTRICT COUNCIL
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DISTRICT COUNCIL
WAIRARAPA COUNCILS
REGISTRATION OF PREMISES
Business Details New Business Yes No
Full name of applicant(s) or company name:
Trading name:
Application Form
Please return your application to the local council
where your business resides. Address details overleaf.
NCS No.
Building Approval Planning ApprovalYes No Yes No
Urinal stalls
Unisex
Male toilets
Staff Only
Female toilets
Accessible
Toilet Numbers:
EHO
Application fee (new only) $
Registration or Transfer fee $
oFFiCE usE onlY:
Conditions to be imposed:
Holloway Street, Carterton
P.O. Box 9, Carterton 5743
t: 06 379 4030 f: 06 379 7832
e: info@cdc.govt.nz
19 Kitchener Street
Martinborough 5711
PO Box 6, Martinborough 5741
t: 06 306 9611 f: 06 306 9373
e: enquiries@swdc.govt.nz
Please indicate the purpose you are seeking this registration
161 Queen Street
PO Box 444, Masterton 5840
t: 06 370-6300 f: 06 378-8400
e:
health @ mstn.govt.nz
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DISTRICT COUNCIL
OFFENSIVE TRADE (No scale plan required)
Fish cleaning
Refuse collection and disposal
Septic tank desludging/disposal of sludge
Storage, drying or preserving of bones, hides, skin or hoofs
Collection and storage of used bottles
CAMPING GROUND (I have attached a plan of the camping ground)
FUNERAL DIRECTOR
HAIRDRESSER
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