Application for Street Busking Submission Form 20092010 by JaymesChapman

VIEWS: 8 PAGES: 2

									                                                    Application for Street Busking
                                                                 Submission Form
                                                                         2009/2010

Please Note: Public Liability Insurance to the value of $5,000,000 is required

Please note: a non-refundable $72 fee is payable upon application



APPLICANT DETAILS:

Full Name: ....................................................................................................................................

Postal Address: .............................................................................................................................

......................................................................................................................................................

Daytime Contact Number(s): .........................................................................................................

Date/s Required:............................................................................................................................

......................................................................................................................................................

The permit must be in the possession of the applicant at all times during the
performance(s).

Location requested and locality plan:




  Office Use Only:
  Receipt No:…………………………….                                             Amount Paid: $………...…….                            Date:………………...
  …………..………
DECLARATION OF CONDUCT:

I/we, the above applicant(s), hereby agree to comply with the following conditions:


1.      Indemnify the Council from any loss, damage or personal and public injury for this
        activity – Public Liability Insurance to the value of $5,000,000 with the South Gippsland
        Shire Council’s interests noted on the policy;

2.      That the location used be left in a clean and tidy condition;

3.      No obstruction will be caused to the pedestrian or vehicular traffic;

4.      A pedestrian crossing of 1.8m will be provided, measured perpendicular from the kerb
        to the street stall as per the Footpath Trading Code.



Parent/Guardian for Children under 16 Years: ……………………......……………………………




Signed: ........................................................................................................................................



Dated: ..........................................................................................................................................




For more information, please contact the Local Laws Department on tel: 03 5662 9258


Please complete and return this submission to:

                                             South Gippsland Shire Council
                                              9 Smith Street (Private Bag 4)
                                                  Leongatha VIC 3953

                                                DX 94026 Leongatha
                                                  Tel: 03 5662 9200
                                                 Fax: 03 5662 3754
                                                T.T.Y: (03) 5662 9371
                                      Email: council@southgippsland.vic.gov.au
                                      Website: www.southgippsland.vic.gov.au

								
To top