Stockwater Race Works
Affected Parties Written Consent
Please return this form to: info@adc.govt.nz or Ashburton District Council, PO Box 94, Ashburton 7740
Completed by Applicant
Name:
Location of Proposed Works:
Description of Proposed Works:
Completed by Person Giving Approval
Name:
Company/Farm:
Contact Phone Number:
Location:
Property Number:
Signature and Date
I/we, the undersigned, being the legal owner/occupier of the above property
(1) have inspected the plan and description of the proposed work
(2) hereby give my/our approval for the proposed works to proceed
(3) understand that, if I give my approval, the Ashburton District Council shall not take into account any effects
that the proposed activity may have on me/us when considering the application.
Signed: _____________________________ Date: _________________________________
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