Written approval of affected persons
Please read this first
This form will be scanned by electronic equipment. It is important that you:
use a blue or black pen to complete this form; and
print clearly.
Please note, in most instances the Council will require the approval of the legal owners and the occupiers of the affected
tararua district council
26 gordon street
po box 115
dannevirke 4942
06 374 4080
Applicant details (Please print in CAPITALS)
Title: Mr Mrs Miss Ms
First names
Address of proposed activity
Brief description of proposed activity
Affected persons (Please print in CAPITALS)
Full name of affected person(s)
Address of affected property
I am/we are the Owner(s) Occupier(s)
You should only sign below if you support or have NO OPPOSITION to approval of the application for resource consent you have
been asked to consider.
. I/Wehavebeengivendetailsofthefullandnalproposalincludingacopyoftheapplicationform,assessmentofthe
2. I/We agree that we have signed the resource consent appliation and each page of the plans shown to us in respect of this
. I/Weunderstandthatbygivingmy/ourwrittenapproval,theCouncilcannottakeaccountofanyactualorpotentialeffectsof
the activity on my/our property when considering the application. The fact that any such effects may occur shall not be relevant
4. Further,I/weunderstandthatatanytimebeforethedeterminationoftheapplicationI/wemaygivenoticeinwritingtothe
Councilthatthisapprovaliswithdrawn,underSection104(4) of the Resource Management Act 1991.
I have authority to sign on behalf of all the other owner/occupier(s) of the property.
/ /
2 0
Signature of affected person(s) Date
Section 94 Resource Management Act 1991