LOCAL GOVERNMENT ACT 1989 -SCHEDULE 10 and 11 /
Office Use Only
Return To / BUILDING SERVICES / Class / Type / Year / Number
Email / / BG / SOP / 201
Or / any City of Greater Geelong Customer Service Centre / Prop No.
APPLICANT DETAILS
You are the Agent of Owner Owner Builder / Contractor (tick applicable box)
Name
Address
Suburb / Postcode / Phone
Mobile / Email
BUILDING / CONTRACTOR DETAILS - who will undertake the works.
Name
Address / Suburb
Email / Phone / Mobile
PROPERTY DETAILS
Number / Street
Suburb / Postcode
PROPOSED WORK
Description of building work:
Why are you applying for this permit?
Location of occupancy:
What part of Council land will you be occupying? / Footpath Nature-Strip RoadwayLaneway
Equipment occupying Council land:
How will you be undertaking this work
eg: excavator, scissor lift, ladder etc
Occupation Dimension: / ( Length m x Width m ) = m 2
( Length mx Width m ) = m 2
Proposed date(s):
Duration of works: / ( Hours: am/pm - am/pm ) ( Days: ) (Weeks: )
On Street Parking:is your work area within an outer street parking area? / NO YES, if yes how many parking bays will be occupied?
Associated Permits / Planning Permit # / Building Permit #
Does your site require a Construction Management Plan? / NO YES, if unknown, check your planning permit conditions.
APPLICANT AGREEMENT
The Applicant hereby agrees to the tax invoice payment terms of strictly 30 days. In the event of full payment not being made the applicant agrees to pay all legal and/or collection charges incurred in recovery of any overdue amounts.
Name / Signature / Date
NOTE:
Pursuant to Section 248 of the Building Act 1993, a person must not act on behalf of an owner of a building or land for the purpose of making any application, appeal or referral under this Act or the regulations unless the person is authorised in writing by the owner to do so. Penalty: 120 penalty units
APPLICATION CHECKLIST MANDATORY INFORMATION REQUIRED
Council Report and Consent for public protection pursuant to Regulation 604(4) must be approved before the Street/Footpath Occupation Permit can be granted.
Completed Application Form
Certificate of Currency for public liability insurance (10 million minimum) of person undertaking the works.
Traffic management plan(s) for the proposed works prepared by a qualified person, All works are to be clearly delineated and signed in accordance with the Road Management Act 2004.
Note: These may require external agencies approval – refer to list below.
Copy of courtesy letter for approved detour routes as indicated on your traffic management plan. The letter must be approved by Council before distributing. There is a requirement for 7 days notification to relevant properties.
EXTERNAL AGENCIES
Vic Roads - MOA (Memorandum of Authorisation) approval.
Electrical Services - “No Go Zone” approval.
Buslines - Bus Routes and Bus Stops.
CFA - Country Fire Authority.
PRECRIBED FEE STRUCTURE FOR STREET OCCUPATION
Permit / $255.00
Space Occupation / $3.70/m2 per week
Temporary Street Car Parking Occupation Short Term
(less than 3 weeks) / $42.75 per Bay / Day metered
$22.95 per Bay/ Day unmetered
Temporary Street Car Parking Occupation Long Term
(greater than 3 weeks) / $34.15 per Bay / Day metered
$18.85 per Bay/ Day unmetered
NOTE:
- Extensions to permits are not automatic
- Additional permit fees and charges will apply.
- Council is collecting the information on this form for the purpose of processing your application for a Street Occupation and/or Parking Permit.
- The information will not be disclosed to other parties unless required by law.
- Failure to provide this information may result in your application not being processed.
- You may access any private information provided by contact Council on (03) 5272 4500
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