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
/ /
Please return your application to the
local council where your business
resides. Address details overleaf.
CC to Trade Waste Officer:
Yes, date: No
/ /
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
/ /
(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 $
