Application for out of Hours Approval

Application for out of hours approval

BEFORE LODGING YOUR APPLICATION

Please check that you have read and completed all sections of this form.
To lodgeyour application, sendan email to .
All requests for out of hours work must be made at least ten (10) business days prior to the proposed works being undertaken.
EDQ Development Assessment reserves the right to withdraw an approval if a complaint is received in relation to out of hours work.
For general queries contact the EDQ Development Assessment team at .

1. PROPERTY DESCRIPTION

Identify all lots and roads, including any part of a lot or road on which the works are proposed:

Priority Development Area
Street address (i.e. unit/street number, street name, suburb/town and post code)
Lot on plan description (e.g. Lot 3 on RP123456) and roads

2. APPLICANT DETAILSAND SITE CONTACT DETAILS

The applicant is responsible for ensuring the accuracy of the information provided because any permit issued will be issued to the applicant.

Applicant name
Company/organisation
Contact name
Postal address
Telephone number
Email address
Site contact name
Company/organisation
Contact name
Telephone number
Email address

3. DETAILS OF THE PROPOSED OUT OF HOURS WORKS

Complete the table below to give details of the proposed out of hours works.

Provide reasons as to why the works cannot be undertaken during normal construction hours.
PDA Development Approval and relevant conditions. / DEV20/
Condition no
Description of works including the proposed machinery/equipment (including any temporary lighting) to be used during this time and number of workers on site. / Further details attached:
Date and time (in 24hr format) of proposed out of hours works.
List start and finish times being sought.
Identify the location extent of the proposed works. / Further details attached:
Will there be any truck movements to and from the site. If yes, provide an estimate of how many movements and advise of route. / Further details attached:
Is there an endorsed Construction Management Plan and/or Traffic Management Plan for the works? / Yes – provide details:
No
Provide detailed description of potential impacts (e.g. noise/lighting/traffic/vibration and access in the locality) as a result of the works.
Identify measures to mitigate potential impacts. / Further details attached:
Provide a comprehensive report of the outcome of community and stakeholder engagement. / Report attached
Attach all required permits/approvals required for these works / Permits/Approvals attached:

6. PRIVACY STATEMENT

Information collected is also subject to the Right to Information Act 2009 and the Information Privacy Act 2009.The information provided may be publicly released and or provided to third parties and other government agencies—but only for the purposes for which the information is being collected.The proponent's personal information will be stored on departmental files and may be disclosed for purposes relating to the processing and assessment of the application or as authorised or required by law.

7. APPLICANT’S DECLARATION

The applicant warrants that the information provided to the EDQ Development Assessment Team in relation to this application is true and correct and acknowledges that if any information is knowingly false, the applicant may be exposed to criminal penalties under section 165 of the Economic Development Act 2012.

By making this application, I declare that all information in this application is true and correct to the best of my knowledge and I will abide by the conditions of approval.

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Signature of applicantPrint name and position

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Date