APPLICATION FORM STORMWATER DISCHARGE POINT AND EASEMENT DRAIN DETAILS by tbt78273

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									  APPLICATION FORM
  STORMWATER DISCHARGE POINT
  AND EASEMENT DRAIN DETAILS
                                                                                                     Murrindindi Shire Council
  Note: This is NOT a Permit

Please complete and lodge this application form to Murrindindi Shire Councill including a $20.00
processing fee
Allow up to 14 days for processing and forwarding of Stormwater Discharge Point Advice


DATE:        …………/…………/………                                                                        (Office Use)   ………………………


INFORMATION TO BE: (Please tick)                        COLLECTED [              ]      SENT OUT [        ]          FAXED [   ]


APPLICANT DETAILS:


NAME:


ADDRESS:


PHONE NO:                                                            FAX NO:


PROPERTY ADDRESS:


HOUSE NO:                                                            LOT NO:

STREET NAME:

NEAREST INTERSECTING ROAD:

SUBURB:                     __________________________________________________

PROPOSED DEVELOPMENT TYPE:
(Please tick below                                                           EASEMENT DRAIN DETAILS REQUIRED:
                                                                             ie depth, size of drain, location, offset, etc
HOUSE - EXTENSION                           [      ]

NEW SINGLE DWELLING                         [      ]                         (Please tick below)

DUAL OCCUPANCY                              [      ]                         Rear Easement Location:             [      ]
MULTI-UNITS, Specify No ____ [                     ]                         Side Easement Location:             [      ]
COMMERCIAL, RETAIL                          [      ]                         Plan Reference:                     [      ]
INDUSTRIAL                                  [      ]


OTHER (Specify): .........................................................

ADDITIONAL INFORMATION (Plan, Sketch) PROVIDED: ……………………………………………………......

                  For further information, please contact the Assets and Development Coordinator 5772 0340

If posting, send to: Assets & Development Co-ordinator, Murrindindi Shire Council, PO Box 138, Alexandra, VIC 3714

 FURTHER REQUIREMENTS/INFORMATION:

 A Consent to Work on Road Reserve OR Works Permit is required for any excavation works in a road reserve or
 drainage easement. Statutory fees apply.
 Dial Before You Dig - One Call Service (MOCS) phone 1100 for existing underground service information.

								
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