Please return this form to: info@adc.govt.nz or Ashburton District Council, PO Box 94, Ashburton 7740
RCAP01
VER 1.4
Nov 2017
Applicant Details
Applicant(s) name:
(please write all
names in full)
Applicant address:
Work number:
Mobile number:
Home number:
Email address:
Primary Contact (if different from applicant)
Name:
Address:
Home number:
Mobile number:
Work number:
Email address:
Site Information
Location of proposed works:
Legal description:
Valuation reference (on rates notice):
Owner's name:
Occupier's name:
Description of Activity
Describe clearly the activity which this application is for, including why Resource Consent is required (ie. the rules or standards
in the District Plan or National Environmental Standard that the proposal needs consent for):
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Resource Consent
Application Form (Form 9)
(Section 88, Resource Management Act 1991)
Type of resource consent required:
Subdivision
Land Use
Is the site on which it is proposed to carry out the activity
contaminated i.e., is a listed HAIL site (it is identified in
the Environment Canterbury contaminated land
database), or is the applicant or their agent aware of any
contamination.
Note: that as well as industrial type activities this list
also includes but is not limited to sheep dips, market
gardens, orchards, glasshouses, spray sheds
associated with agricultural or horticultural activities
where hazardous materials may have been stored as
well as places where vehicles have been repaired or
dismantled or fuel stored.
Yes
No
If yes please state details:
If yes have you provided a Preliminary Site Investigation
under the Resource Management (National
Environmental Standard for Assessing and Managing
Contaminants in Soil to Protect Human Health)
Regulations 2011?
Yes
No
Other Resource Consents
Does your application require additional resource
consents from this Council i.e. if this application is for a
land use consent are you also applying for a subdivision
resource consent or vice versa?
Yes
No
If yes please summarise what the other application is for:
Are resource consents required from Environment
Canterbury? (Please phone ECAN on 0800 324 636 if
you are unsure)
Yes
No
If yes tick the resource consents you require:
Coastal Permit
Land Use Consent
Discharge Permit
Water Permit
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If an ECAN consent has already been applied please provide -
ECAN reference number:
Application status i.e. applied for, granted etc:
Assessment of Environmental Effects (AEE)
Describe the effects of your proposal here (the relevant assessment matters in the District Plan will provide guidance on what
you need to cover. You may also like to look at guidance prepared by the MFE on the subject, available here:
http://www.mfe.govt.nz/publications/rma/everyday-guide-rma-applying-resource-consent
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Site Visit Requirements
Is there anything Officers need to be aware of before visiting the site? (e.g. dogs, stock, hazards etc):
I/we provide the following information in support of this application to satisfy the requirement of Section 88 of the
Resource Management Act 1991 and applicable requirements of the Ashburton DIstrict Plan.
Affected Person Approval form(s)
The position of all new boundaries (plans should be to a stated scale and show a north point)
The areas of all new allotments (not required for cross-lease, company-lease or unit plans)
The location and area of existing and new reserves to be created, including any esplanade reserves,
esplanade strips or access strips
I have attached a separate assessment of environmental effects or use the box on the previous page
Any other matters of note
Declaration
I/we certify that, to the best of my knowledge and belief, the information given in this application is true and correct.
I/we accept that I/we have a legal obligation to comply with any conditions imposed on the Resource Consent should this
application be approved.
I/we understand that the Council may charge me/us for all costs actually and reasonably inccured in processing this
application. Subject to my/our rights under section 357B and 358 of the RMA to object to any costs, I/we agree to pay all the
fees and charges levied by the Ashburton District Council for processing this application, including a further account if the
cost of processing the application exceeds the deposit paid. Without limiting the Council’s legal rights, if any steps, including
the use of debt collectors, are necessary to recover unpaid processing costs, I/we agree to pay all costs of recovering those
processing costs. If this application is made on behalf of a trust (private or family), a society (incorporated or unincorporated),
or a company, in signing this application I/we are binding the trust, society or company to pay all the above costs and
guaranteeing to pay all the above costs in my/our personal capacity.
Signature:
Date:
Please print your name:
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click to sign
signature
click to edit
Check Sheet
I/we provide the following information in support of this application to satisfy the requirements of Section 88 of the
Resource Management Act 1991 and applicable requirements of the Ashburton District Plan.
Note: This is a preliminary check list only. It is general in nature and does not cover all rules in the District Plan and, not all of
the information is relevant to all types of application. Please check with a planner at the Council if you are unsure of the
information requirements for your particular application. Please also note that the detailed technical review of your
application may identify the need for you to supply further information, in which case you will be advised as soon as possible.
Application form (one copy):
Complete application form, including a full description of the proposal
Completed Assessment of Environmental Effects
Location of application site:
- Copy of current Certificate of Title, or
- Copy of purchase agreement, where Certificate of Title not yet issued
Application base fee/deposit:
Amount paid: $ (internet banking/cheque/paid at counter)
NOTE: An application will not be accepted for processing if fees are outstanding
NOTE: Internet banking to include the name of the applicant and recource consent number (if known) or
the letters "RC" in the reference field
NOTE: A full digital copy of the application and attachments should be provided or forwarded within 24 hours
to avoid attracting an $80 scanning fee. Digital format only applications are also accepted and should be sent
to info@adc.govt.nz
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Doors and windows
Note: This is a preliminary check list only. It is general in nature and does not cover all rules in the District Plan and, not all
of the information is relevant to all types of application. Please check with a planner at the Council if you are unsure of the
information requirements for your particular application. Please also note that the detailed technical review of your
application may identify the need for you to supply further information, in which case you will be advised as soon as
possible.
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Notes for the Applicant
1. All applicants are asked to check the accuracy of the information supplied. Inaccuracies in information supplied can
cause difficulties at a later date including additional costs, delays and legal proceedings initiated by the Council and/or or by
other persons. Please see the check sheet page five for how to identify your payment if you are paying Council through
online banking.
2. The required minimum application fee must be paid before processing of this application will start.
3. Additional charges may be payable if the cost of processing the application exceeds the application fee paid. If you are
an agent for the applicant and do not wish to be legally liable for additional fees then you should ask the applicant to sign
the form.
4. Depending on the nature of the proposal other consents/licences may be required.
5. This application under the Resource Management Act 1991 is in addition to any building consent application required
under the Building Act 2004.
6. When this application is lodged with the Ashburton District Council, it becomes public information and is available for
public inspection. If there is commercially sensitive information in the proposal, please let us know.
7. If your application is inadequate, it may be rejected and returned to you. You will be advised as to what additional
information is required and will need to submit a new application with the additional information. There is an administration
charge for rejected applications. To avoid delays and cost it is in your best interests to submit a complete application.
8. If there is evidence that your site is contaminated you must provide an assessment of the proposal against the National
Environmental Standard for Assessing and Managing Contaminants in Soils.
9. If you are relocating a building, you will be required to gain confirmation from a suitably qualified person of the cost of
works to put the structure on permanent foundations and any external works required. You will also be asked to pay a bond
or commit to an undertaking that funds are available to Council to complete the works should they not be completed in
accordance with the consent. Failure to supply this or an adequate justification as to why such details arenot required may
result in delay or refusal of the application.
Privacy Information
The Council requires the information you have provided on this form to process your application under the Resource Manage-
ment Act and to collect statistics. Under this Act this information, together with associated reports and attachments, can be
made available to members of the public, including business organisations, community groups and the media. You have the
right to request access to personal information held about you by the Council, and you can request that it be corrected.
Financial Contrbutions
If your resource consent application is for:
- A subdivision in a residential, Aquatic Park or business zone; or
- The construction of more than one residence on a site; or
- Service, industrial, commercial, recreational, or community activities or visitor accommodation;
It may be subject to financial contributions in respect of water and sewer connections, stormwater disposal, road widening,
construction and or formation, open space and reserves, and esplanade provisions. If in doubt, please contact the Planning
department.
Assessment of Environmental Effects
Your resource consent application must include an “Assessment of Effects” as outlined in the Fourth Schedule of the
Resource Management Act1991 (a copy of the Fourth Schedule is included in this form).
In your assessment of effects please
- Describe any effects (actual, potential, negative or positive) produced by your proposal e.g. noise, glare, odour, traffic,
visual, vibration, dust, jobs, impact on traffic safety, etc.
- If your proposal generates any negative effects, please explain how they may be mitigated (lessened) remedied, or avoided
e.g. landscaping, provision of onsite car-parking etc.
The next page of the form is only useful for small scale proposals. A larger, more in-depth assessment may be required for
applications which are likely to produce a range of effects.
If you have any queries about an assessment of effects or why it is required, please contact the Planning Department of the
Ashburton District Council.
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Notes for the Applicant continued
If you would like some help with your assessment of effects, the section of the District Plan called “Assessment Matters” lists
a range of specific effects/questions relevant to your application that the Council will consider. Contact the Planning
Department if you would like a copy.
Fourth Schedule of the Resource Management Act 1991
Assessment of Effects on the Environment
1 - Matters that should be included in an assessment of effects on the environment
Subject to the provisions of any policy statement or plan, an assessment of effects on the environment for the purposes of
section 88 should include—
(a) a description of the proposal
(b) where it is likely that an activity will result in any significant adverse effect on the environment, a description of any
possible alternative locations or methods for undertaking the activity
(c) [Repealed]
(d) an assessment of the actual or potential effect on the environment of the proposed activity
(e) where the activity includes the use of hazardous substances and installations, an assessment of any risks to the
environment which are likely to arise from such use
(f) where the activity includes the discharge of any contaminant, a description of—
(i) the nature of the discharge and the sensitivity of the proposed receiving environment to adverse effects; and
(ii) any possible alternative methods of discharge, including discharge into any other receiving environment
(g) a description of the mitigation measures (safeguards and contingency plans where relevant) to be undertaken to help
prevent or reduce the actual or potential effect
(h) identification of the persons affected by the proposal, the consultation undertaken, if any, and any response to the views
of any person consulted
(i) where the scale or significance of the activity’s effect are such that monitoring is required, a description of how, once the
proposal is approved, effects will be monitored and by whom.
1AA -
To avoid doubt, clause 1(h) obliges an applicant to report as to the persons identified as being affected by the proposal, but
does not—
(a) oblige the applicant to consult with any person; or
(b) create any ground for expecting that the applicant will consult with any person.
1A - Matters that must be included in an assessment of effects on the environment
An assessment of effects on the environment for the purposes of section 88 must include, in a case where a recognised
customary activity is, or is likely to be, adversely affected, a description of possible alternative locations or methods for the
proposed activity (unless written approval for that activity is given by the holder of the customary rights order).
2 - Matters that should be considered when preparing an assessment of effects on the environment
Subject to the provisions of any policy statement or plan, any person preparing an assessment of the effects on the
environment should consider the following matters:
(a) any effect on those in the neighbourhood and, where relevant, the wider community including any socio-economic and
cultural effects:
(b) any physical effect on the locality, including any landscape and visual effects:
(c) any effect on ecosystems, including effects on plants or animals and any physical disturbance of habitats in the vicinity
(d) any effect on natural and physical resources having aesthetic, recreational, scientific, historical, spiritual, or cultural, or
other special value for present or future generations
(e) any discharge of contaminants into the environment, including any unreasonable emission of noise and options for the
treatment and disposal of contaminants:
(f) any risk to the neighbourhood, the wider community, or the environment through natural hazards or the use of
hazardous substances or hazardous installations.
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Other matters:
You will also need to provide an assessment against the relevant parts of the District Plan or National
Environmental Standard
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