Pre Purchase Home Inspection Form - PDF

					                                                                                                                                                                   FOOD PREMISES PRE-PURCHASE INPSECTION APPLICATION
Please print clearly in BLOCK LETTERS with a black pen.                                           Under the Food Regulation 2004 and
                                                                                                  AS 4674-2004 – Design construction and fitout of food premises
Please tick the appropriate boxes.
i
  1        Premises details
Premises current name

Type of business

Location

                                            No. and Street

                                             Town/Locality                                                                             Postcode


  2        Applicant details

Your name                                           Full name

Postal address                                  Street or PO

Daytime contact details                                Phone                                                       Fax

                                                      Mobile                                                     Email

Signature of applicant(s)

                                                                                                                                          Date           /   /

  3        Existing owner(s)/proprietors                                            I hereby permit Council to enter the premises for a pre-purchase
                                                                                    inspection and provide a copy of the report to the applicant
Your name                                           Full name

Postal address                                  Street or PO

Daytime contact details                                Phone                                                       Fax

                                                      Mobile                                                     Email

Signature of owner(s) /
proprietor(s)
                                                                                                                                          Date           /   /

Disclaimer                                                        Council’s inspection is for the purpose of pre-purchase inspections. If Council identifies
                                                                 serious breaches of the Food Act or other relevant legislation on inspection Council may
                                                                take appropriate enforcement action. Council may also disclose contents of pre-purchase
                                                                    inspections to a third party if required to do so by another relevant statutory provision.

Note                        Council's inspection involves a visual inspection of the premises to assess compliance with the Food Regulation 2004
                           and the Australian Standard 4674-2004 - Design, construction and fit out of food premises at the time of the inspection.
                            The inspection DOES NOT include assessment of compliance with the Building Code of Australia; investigation of
                             the presence of development approvals, and compliance with any such approvals; investigation of the presence of
                                outstanding notices and orders on the subject premises; or assessment of the structural integrity of the building.

    OFFICE USE ONLY                                             BEGA V`ALLEY SHIRE COUNCIL

                                                                Receipt No.                                       Allocation No.     1111-001
                                                                Receipt date

                                                                CS staff                                         Application fee $
 FOOD pre-purchase inspection APPLICATION.doc


Forms may be lodged at Council’s office in Bega │     PO Box 492 Bega NSW 2550 │T    (02) 6499 2222 | F   (02) 6499 2200 │   www.begavalley.nsw.gov.au             1 │1

				
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Description: Pre Purchase Home Inspection Form document sample