COUNCIL – Land Owner Consent Request Land Owner Consent – Request 1Introduction2Request3Declaration You can use this form to Request consent to carry out works on a property your organisation uses, that is owned or managed by Council. This is comparable to a tenant asking a landlord permission to carry out work. If Council is fully funding and managing the works project you DO NOT need complete this request. If the property is Crown Land you may also require land owner consent from the Minister for Energy, Environment and Climate Change to be obtained via the Department of Environment, Land, Water and Planning. For information or enquiries contact bsw.planning@delwp.vic.gov.au Who can use this form Organisations that use Council owned or managed property If your group is likely to carry out a series of work or projects for the same property over 12 months, complete this application form once with all details. While completing this form, we will request Property details Discussion details with Council and/or co-tenant and who you spoke to Who will carry out the works Project details Designs Site plan Quotes It will take about 10 minutes to complete this form. After you submit this form We will send you an email receipt to confirm we have received your application We will contact you if we need more clarification or more details We will let you know the outcome within 28 days, excluding time you need to prepare and submit extra details. What happens with your information? Information requested on this form is required by Swan Hill Rural City Council in order to process your application. We will handle any personal information you provide on this form in accordance with the Privacy and Data Protection Act 2014. We record this information on our customer databases and make it available to relevant Council staff in line with our Privacy Statement. You can access your personal information by contacting our Privacy Officer. Property detailsProperty nameAddress(Required)Initial discussionsHave you discussed the work with a Council liaison officer?(Required) Yes No Name of Council liaison officer you spoke with(Required)Has the project been discussed with facility co-tenant/s?(Required) Yes No Not applicable Name of facility co-tenant/s you spoke with(Required)Project detailsProject name(Required)Provide a brief description of why the project is needed(Required)Provide a brief description of the project and what it will achieve(Required)Works details All individuals engaged to complete works have appropriate and current insurance (including Public Liability) and are suitably qualified.Estimated start date(Required) Estimated end date(Required) Who will carry out the work? (select all that apply)(Required) Contractor Volunteers Unknown at this stage Are there any structural works?(Required) Yes No Works include (select all that apply)(Required) Building / structure removal Building / structure alteration Vegetation removal Tree removal Earthworks / trenching / boring Road pavement works Trades Other Other(Required)Where are the works to occur? (select all that apply)(Required) Indoors - within a building Outdoors - building exterior What is the estimated cost of the project?(Required)Supporting documents Supporting documents can include: a site plan specifications plan of works quotes other information If uploading plans make sure they include: Permanent structures in relation to property boundaries Proposed works Dimensions of proposed works Locations and names of streets/streetfrontagesUpload supporting documents(Required) Drop files here or Select files Accepted file types: doc, docx, heic, jpg, jpeg, gif, pdf, Max. file size: 5 MB, Max. files: 4. Contact detailsName(Required)OrganisationPositionPostal address(Required)Phone(Required)Email(Required) DeclarationDeclaration 1(Required) I declare that all the information given is true and correct Required Declaration 2(Required) I declare I have the ability to bind the organisation represented in this application Required Declaration 3(Required) I consent to Swan Hill Rural City Council using the information provided on this form for assessment of the request Required Declaration 4(Required) I understand details may be shared with Council officers across multiple departments to fully consider the request Required Name(Required)
