City of Greater Geelong

Application for Kerb Side Numbering Permit

I/We the undersigned hereby apply to the City of Greater Geelong for a Kerb Side Numbering Permit.

Name of Applicant
/
Date
/ / /
Applicant Trade Name / ABN
Postal Address
Phone /
Fax
/
Email
Details of Product or Service

I the undersigned hereby agree to abide by the conditions set out for kerbside numbering.

The personal information requested on this form is being collected by Council for the purpose of registering and administering your application for directional signage. The personal information will be used solely by Council for that primary purpose or directly related purposes. The information will not be disclosed except as required by law. If you fail to provide this information, your application may not be processed. You may apply to Council by telephoning 5272 4384 for access to and/or amendment of the information.

This application may be submitted with relevant documentation (listed below) for assessment as part of a “Consent for Works Within Road Reserves Permit” (MINWO2) at Council’s Brougham Street, Customer Service Centre, or by mail, Addressed to:

Infrastructure Management Unit

Engineering Services

City of Greater Geelong

PO Box 104

GEELONG VIC 3220

For further information please contact:

Mr. Aaron McGlade

Infrastructure Projects Engineer

Telephone Number: (03) 5272 4538

The personal information requested on this form is being collected by Council for the purpose of registering and administering your application for directional signage. The personal information will be used solely by Council for that primary purpose or directly related purposes. The information will not be disclosed except as required by law. If you fail to provide this information, your application may not be processed. You may apply to Council by telephoning 5272 4384 for access to and/or amendment of the information.

Signed:

Date:

Required Documentation: Copy of Registration of Business, Australian Business Number (ABN), Copy of current Public Liability Insurance Policy ($10,000,000)

The personal information requested on this form is being collected by Council for the purpose of registering and administering your application for directional signage. The personal information will be used solely by Council for that primary purpose or directly related purposes. The information will not be disclosed except as required by law. If you fail to provide this information, your application may not be processed. You may apply to Council by telephoning 5272 4384 for access to and/or amendment of the information.