Request For Copy of Plans by d56FZ3E

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									                                                                                                                                                                                   PO Box 35
                                                                                                                                                                                 Echuca 3564

                                                                                                                                                                       Tel (03) 5481 2200
                                                                                                                                                                      Fax (03) 5481 2290
                                                                                                                                                                   Free call 1300 666 535
                                                                                                                                                      E-mail: shire@campaspe.vic.gov.au
                                                                                                                                                Website: www.campaspe.vic.gov.au

                                                    Request for Copy of House Plans
                        This form is to be sighted, filled out and signed by the customer, only after noting that this is a
                                          “NON-REFUNDABLE SEARCH AND RETREIVAL FEE $86.00
                                                 YOU MIGHT INCURR PHOTOCOPYING FEES”

   When requesting large amounts of copies, or copies from more than one file, the fee may be increased. Customers should
                          also be advised that documents for some properties may not be available.

DATE REQUESTED: __________________________________

Property Lot No: ________________________ Street No: _____________________ LP/PS: ___________________________
Details:
         Street: _______________________________________________________ Suburb: __________________________

What plans
Are required: _________________________________________________________________________________________

Reason for
Request: ____________________________________________________________________________________________

Contact
Person: Name: ______________________________________________________ Phone No: _______________________

              Address: ____________________________________________________ Post Code: _______________________

Owner:        Name: ______________________________________________________ Phone No: _______________________

              Address: ____________________________________________________ Post Code: _______________________

Verification of Ownership or Written Owner’s Consent: Received by: ______________________________________________

Plans to be:                             Picked up                                    or                       Mailed

Mailing address: _________________________________________________________________________________________

I understand that this is a search and copy fee and if no documentation is available, the fee will be not be refunded:
Customers signature: _______________________________________
--------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------
PAYMENT DETAILS

Bankcard                                               Mastercard                                               Visa

Card No. ___ ___ ___ ___/ ___ ___ ___ ___/ ___ ___ ___ ___/ ___ ___ ___ ___                                     Expiry Date: __ __ __/ __ __ __

Cardholders Name: ___________________________________                                      Amount of: $______________

Signature: ____________________________________________________

------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------
OFFICE USE ONLY

Receipt to: General Ledger – BSER - $86.00

Fee received: $ ___________________(Minimum fee $86.00)

Received by: ________________________________________ Date: ________________________________

Receipt No: ________________________________ (Forward to Building Department)

C:\Docstoc\Working\pdf\64b9a48d-44e6-4743-9b15-2bb5043b94d7.doc 15-Sep-12 3:59:41 PM

								
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