APPLICATION TO HOLD STREET STALLS
Local Government Act 1993 Section 68
Locked Bag 155, Coffs Harbour 2450; DX 7559
Administrative Centre, 2 Castle Street, Coffs Harbour
Email: Phone: (02) 6648 4000 Fax: (02) 6648 4199
Website: www.coffsharbour.nsw.gov.au ABN 79 126 214 487
1. Details of the applicant
It is important that Council is able to contact you if more information is required. Please give as much detail as possible.
Mr Ms Mrs Dr Other:
Given name/s / Surname
Company/organisation / ABN
Postal address
Suburb or town / State / Postcode
Daytime telephone / Mobile
Email address
The questions below are optional and the information will only be used for the purposes of providing better service.
Place of birth: / Main language spoken: / Aboriginal or Torres Strait Islander:
Yes No (Tick one)
Do you have special needs for assistance with this application? / Yes No (Tick one)
If yes, please specify:
2. Location details
SAWTELL
15 & 17 First Avenue, Sawtell (fronting vacant shops south of the Post Office; available 7 days)
38 First Ave, Sawtell (fronting vacant shop or outside Sawtell RSL (excluding RSL ext); available 7 days)
WOOLGOOLGA
Cnr Beach & Nightingale Sts, Woolgoolga (outside National Australia Bank)
Cnr Beach & Nightingale Sts, Woolgoolga (outside Pharmacy, Nightingale Street side)
CITY SQUARE (Trading Places-Footpath Activation Trial 1/10/2017- 31/03/2018)
Please refer to http://haveyoursay.coffsharbour.nsw.gov.au/TradingPlaces
3. Briefly describe the purpose of the street stall
Office Use Only
Date received / Application fee (if applicable) / Receipt No.
4. Dates and times requested to hold street stall Page 2
MONTH / DAY / DATE / TIME / MONTH / DAY / DATE / TIME
5. Insurance details
Conditions of approval:
· Persons or organisations are required to hold current public liability insurance for a minimum of $10 million.
· Council should be noted on the policy as an interested party.
· When conducting a street stall, you are to position equipment so that:
- access and egress from any shop or shopping complex is not impeded;
- pedestrian flow on the footpath is not restricted or redirected so that pedestrians are placed at risk of injury;
- access and egress from the pedestrian crossing is not impeded;
- line of sight of motorists or pedestrians, particularly near pedestrian crossings is not impeded.
Insurance Company Name / ABN
Policy Number / Expiry Date
Copy of current Liability Policy attached: / Yes No (Tick one)
6. Applicable fees and charges
To view the applicable fees and charges associated with this application please refer to Council’s adopted fees and charges at www.coffsharbour.nsw.gov.au/fees
7. Privacy and personal information protection notice
· this information is voluntarily required to process your request and will not be used for any other purpose without seeking your consent, or as required by law;
· your information may comprise part of a public register related to this purpose;
· your application will be retained in Council’s Records Management System and disposed of in accordance with the Local Government Disposal Authority;
· your personal information can be accessed and corrected at any time by contacting this Council.
Applicant’s Signature/s
I declare that to the best of my knowledge all particulars supplied by me are correct and completed. I understand that inaccurate or false statements may cause my application to be delayed or rescinded.
Signature/s : …………………………………………………………………………… Date: .……/……../……..
Application to hold Street Stalls [FRM-E003] 1 October 2017