Swimming pool fence exemption application by K7ox31

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									Swimming pool fence exemption
application

Postal Address                                           Building and Plumbing                                    Internet
PO Box 159                                               Ph: 07 3205 0555                                         www.moretonbay.qld.gov.au
Caboolture QLD 4510                                      Fax: 07 3205 0599                                        mbrc@moretonbay.qld.gov.au

Fees listed are applicable 1 July 2012 – 30 June 2013                                                             ABN: 92 967 232 136
Applicant details:
Applicant must be pool owner or provide proof of authority (i.e. guardianship, enduring power of attorney, etc) to apply on
behalf of the pool owner
Company name (if applicable):
   Mr        Mrs      Ms        Miss
Given name/s:                                                                     Surname:

Postal address:

Home number:                                        Mobile phone:                                        Work phone:

Details of swimming pool:
Street address:

Real property description:       Lot:                                                        Plan:
   Existing swimming pool           Proposed swimming pool (not yet constructed)
Building permit number for swimming pool:

Customer summary:
This application form shall be accompanied by the following:
   Application fee of $605.00
    A site plan that is dimensioned and/or drawn to an acceptable scale (normally 1:200) showing the location of the swimming pool in
relation to; the boundaries of the property, all other buildings and structures and all natural and developed features on the property
such as stands of timber, landscaped areas, fencing, retaining walls and the like
   Written advice which relates to the person’s disability and why the exemption is necessary
   Medical evidence to support this application
   Proof of authority (i.e. guardianship, enduring power of attorney etc) to apply on behalf of the pool owner (if applicable)
Note: The lodgement of this application shall not be taken to be an approval. Once your application has been decided you will be
given an information notice. If the exemption is granted on conditions, the applicant must comply with each condition attached to the
exemption.

Signature:                                                                                                Date:

                                                                   Office use only

CSO: ______________________________________________ Application number: ___________________________________

Receipt number: ________________________ Amount: ____________________ Date: ________________________________

Privacy statement
Moreton Bay Regional Council is collecting your personal information for the purpose of assessing your application for a swimming pool fence
exemption. The collection of this information is authorised under Section 240 of the Building Act 1975. Your information will not be given to any other
person or agency unless you have given us permission or we are required by law.




R25                                                                   Page 1 of 2                                                      September 12
Payment options:

In person
Present this form at any of the Moreton Bay Regional Council Customer Service Centres:
Caboolture: 2 Hasking Street, Caboolture
Strathpine: 220 Gympie Road, Strathpine
Redcliffe: Irene Street, Redcliffe

By mail
Please make all cheques/money orders payable to Moreton Bay Regional Council or complete your credit card details below and
return the form with payment to council.



Credit card type:      MasterCard          Visa

                                                                                                 Expiry
 Card number:
                                                                                                 date:

Cardholder name:

Signature:

Amount payable:         $                                                       Date:

Receipt address:




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