Resource Consent Affected Person(s) Written Approval Form 1
To: Gore District Council
I/We (full names):
Being the: Owner and Occupier Owner Occupier
of the property situated at (address and/or legal description of your property):
I/we have read and understand the information on page 3 of this form and give written approval to the
proposal by (name of applicant(s)):
to (description of proposed activity):
on the following property (address of application site):
The applicant has supplied:
The full application for resource consent
The Assessment of Enviromental Effects
Site layout plans
Plans of buildings proposed
Resource Consent
Affected Person(s)
29 Bowler Avenue, Gore 9710
PO Box 8, Gore 9740
Phone 03 209 0330
Important: Please read the notes on page 3 to ensure you are aware of your rights.
Please be aware that these details are available to the public
Resource Consent Affected Person(s) Written Approval Form 2
I/we have read and understand the application as described above and have signed and dated the
application and plans as attached.
If there are multiple owners or occupiers on a site, each party needs to individually sign the application
documents and this form; or tick the declaration box below:
Contact person (name, and designation if applicable):
Postal address:
Email address: Telephone:
I am authorised to give written approval on behalf of all owners and/or occupiers (delete one) of this site.
If signing on behalf of a trust or company, please provide additional written evidence that you have
signing authority.
Signed: Date:
A signature is not required if you give your written approval by electronic means
Resource Consent Affected Person(s) Written Approval Form 3
Information for persons asked to give their written approval to a resource consent.
When people wish to build on their land or use a property
in a way which does not comply with the rules in the Gore
District Plan they require permission from the Council
and this is known as a “Resource Consent”.
The person undertaking the development is referred to
as the “applicant” and the formal document submitted to
the Council is an “application”.
The Resource Management Act 1991 sets out various
matters that the Council must have regard to in processing
and considering an application. This includes the views of
those persons who may be adversely affected by
the proposal.
If the applicant or the Council considers that what is
proposed may have an adverse environmental effect on you
greater than the public generally then you are required to
be consulted. You may also be asked to give your written
approval to the proposal. If you do give your written
approval then the Council will not have regard to any
adverse environmental effects that may impact on you.
What should you do if you are asked
to sign this form?
If you are asked to give your written approval to an
application for a resource consent, you should do
the following:
1. Request that the applicant (or their representative)
explain the proposal clearly and fully to you.
2. Study the application and associated plan(s) provided
by them in order understand the effects of the
proposed activity. If there are no plans available at this
stage, you may wish to wait until they are available.
Ask for time to consider the documents if you think
you need it.
3. Decide whether the proposed activity will adversely
affect you or your property. You are entitled to ask the
applicant for more information and you may suggest
amendments to the proposed activity that you consider
would reduce the effects on you. If the proposal is
amended by the applicant, then you should ask for an
amended application and plan(s) to be provided
showing any agreed changes.
4. If you are satisfied that the proposed activity will not
adversely affect you and/or the effects are acceptable
to you, you may decide to sign the affected person’s
approval form and any plan(s) and return these to the
applicant. If you are willing to give your approval subject
to some other conditions being met, this will need to
be the subject of a separate side agreement between
yourself and the applicant. The Council will not accept
“conditional approvals”.
5. If you consider that you will be adversely affected by
the proposal and do not wish to sign the approval form,
you should advise the applicant (or their representative)
(i) In some cases approvals are required for both the Gore
District Council and Environment Southland and you
may be asked to sign two separate forms.
(ii) If you change your mind after signing this form, you
should advise the Gore District Council in writing
that you withdraw your approval. This can be done
at any time before a decision is made on the
resource consent.
However; if the Council determines that the activity is
a deemed permitted boundary activity under sections
87BA of the Act, your written approval cannot be
withdrawn if this process is followed instead.
(iv) Where a property is leased or rented, then consultation
may be required with both the owners and occupiers
of the property.
What happens if you do not give your
written approval?
If you do not give your approval the applicant may amend
their proposal so it fully complies with the rules in the
Gore District Plan. It can then proceed without the need
for a resource consent.
If the applicant wishes to proceed with the proposal as
discussed with you and the Council considers adverse
effects on you will be minor or more than minor then the
Council will formally write to you providing an opportunity
to lodge a submission objecting to it. In some cases
the Council will enable the general public to also lodge
submissions. The final decision on who is adversely
affected by an application and whether the general public
is allowed to lodge a submission is made by the Council
once the application is formally submitted to it.
For Further Information
Should you wish to discuss any aspect relating to
the processing of applications for resource consent
then you should contact the Gore District Council
Planning Services by telephone on (03) 209 0330
or email
Additional information on the processing of
resource consents is also available for the Ministry
for the Environment Web site at the following link
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