Resource Consent
Submission Form
RCAP01
VER 1.2
Jan 2016
Please return this form to: info@adc.govt.nz or Ashburton District Council, PO Box 94, Ashburton 7740
Submitter Details
Name:
Postal address:
Work number:
Mobile number:
Home number:
Email address:
Consent Application
Name of applicant:
Application number:
I/We support this application
The reasons for making my submissions are (please state the nature of your submission and give reasons):
I/We oppose this application
I wish the consent authority to make the following decision (please give details, including the general nature of any conditions
sought):
I wish to be heard in support of my
submission
I do not wish to be heard in support of
my submission
Signature:
Signature and Date
Note: The person making this application must send a copy to the applicant as soon as reasonably practicable
click to sign
signature
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