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09/49742 August 2014
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Date received
Name of CSR
Time received
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Resource management and liquor certificate application
This application is made pursuant to Sections 9 (1)(e), 31 (1)(e) or 55(1)(e) of the Sale of Liquor Act 1989. Your application will also be
subject to all other relevant provisions contained within the RMA 1991.
This form is designed to provide Council with required details, and must be submitted as part of your application. The public can view all
the information provided in your application.
District Plan rules & maps, application forms and land information are available on Council’s website www.wdc.govt.nz
If you have spoken to a member of our planning staff about your proposal, please enter their name ___________________________
It is important that you fully complete all sections
Please refer separate application guidance notes
1 Application details
Attended a pre-application meeting Yes No
Name of party applying for liquor certificate
Name of premises
I need this certificate as part of my application for a/an
On licence (s9)
Off licence (s31)
Club licence (s55)
Description of activity (e.g. byo restaurant; nightclub; tavern; entertainment or function centre)
Operating hours (existing, if relevant, and proposed)
Maximum number of patrons
Number of parking spaces available on site
The activity
Is a permitted activity
Has existing use rights
Has a valid resource consent
Ref
2 Site details
Property address
Legal description
CT
Valuation ref
District plan environment
Property ID
09/49742 August 2014 2
3 Ownership (if different from applicant)
Full legal name of owner
Postal address of owner
Full legal name of occupier (if different from applicant)
Postal address of occupier
Phone no (owner)
Owner email (owner)
4 Agent (if application)
Name of agent
Agent ref
Postal address of agent
Phone no
Email
5 Payer (mandatory)
Full legal name of payer
Postal address of payer
Phone no
Email
Signature (mandatory)
Date
6 Address for service/correspondence
Same as Agent’s details (
if applicable)
Name
Ref no
Telephone
Business
Home
Fax
Postal address
Email
7 Application fees
Please refer to Council’s Resource Consent Guidance Notes and Schedule of Fees & Charges. You are required to pay an
advance fee deposit at time of lodgement. Please refer to Council’s Resource Consent Guidance notes, Schedule of Fees &
Charges and the Resource Consent processing Monitoring Fees attached to the guidance notes.
You will be charged a processing fee when Council has reached a decision on your application. Interim billing may also occur on
applications. The processing charge covers tasks such as site visits, report preparation, information searches, and input from other
Council staff including engineers. Mileage is also charged for.
Please refer to the form titled ‘Resource Consent Processing and Monitoring Fees’ for a detailed list of the processing and monitoring
fees you may be charged. The form lists the current charge out rates. These rates are subject to change and are reviewed every
financial year. Please note that the charge out rate may change during the processing of your application and the fees incurred will be
charged out at the rate applicable at the time the work is done.
All figures are standard fees inclusive of GST; the final fee in any one application will be determined by the Resource Consents
Manager or his/her appointee. Where a consultant is required, Council reserves the right to on-charge costs in accordance with
Council’s Schedule of Fees & Charges.
By submitting and signing this application form you undertake to pay Council’s processing and monitoring fees.
8 Attachment checklist (mandatory requirements are in bold)
Advance fee/deposit
Plans
Covering letter
Certificate of title
Three copies of application
1 x USB or CD (2 colour)
Planning maps
Other (please specify)
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