Application to modify a naturestrip

Cardinia Shire Council

Siding Avenue

Officer Vic 3810

(PO Box 7, Pakenham Vic 3810)

Ph: 1300 787 624
Email:
Web:

Before completing this form, read the Cardinia Shire Council Nature Strip Guidelines 2017

Contact Council’s Park Services team for more information about this policy or application.

Applicant

Name ______

Postal address ______

______

Property address (location of nature strip) ______

______

If you are not the property owner, you must attach a letter of approval from the owner of the property.

Contact phone ______Email______

Proposed naturestrip planting YesNo

I have advised my neighbours on both sides about my proposed naturestrip modifications 

I am hiring a contractor to do these works  

If yes, please provide contractors details and attach a copy of their public liability insurance

Contractor’s business name ______

Contact name ______

ABN ______Contact phone ______

Contact email ______

Do you have a street tree on your nature strip? 

If yes, works must not impact on the street tree. If you have an issue or wish to remove your street tree you must contact Council’s Arborist

I have contacted dial-before-you-dig (Ph: 1100) and identified the location of
all underground services 

I have attached a basic plan of my proposed naturestrip modifications 

A list of proposed plant species to be used is attached (if applicable) 

Yes No

My application complies with Cardinia Shire Council’s Nature Strip Guidelines 2017 

If no, please explain why not ______

______

______

I have attached a copy of a certificate of currency for my public liability insurance policy 

My application includes the installation of synthetic turf  

By signing this application, I acknowledge that I have read, and agree to abide by, Cardinia Shire Council’s Nature Strip Guidelines 2017.

  • I accept that any damage caused to infrastructure within or surrounding the nature strip must be rectified at my cost
  • I accept Occupational Health and Safety legislative liability for works undertaken by myself
  • I understand that maintenance of the nature strip is ongoing and if the nature strip is not maintained in a safe and reasonable manner as per the guidelines, Council can request grass is reinstated on the nature strip
  • I understand that if the modifications are deemed unsafe and urgent rectification is required that this can be undertaken by Council with costs to be paid by me
  • I understand that utility companies have access rights to the utilities located within the nature strip. If access to these is required, then the utility company is only required to level and seed the nature strip. Any damage to planted beds etc will need to be rectified at my cost
  • I understand that all costs of modifications and ongoing maintenance are born solely by myself

Signature ______Date ______

PRIVACY: The personal information supplied on this form is required in order to provide the service requested. It will be used by Council staff and stored in our record system for only as long as necessary. During this time, it can be accessed and amended by you. We will only give your information to a third party with your consent or if we are required to do so by legislation.

Office use only

Date received // File Proposal  Approved

 Not approved

Inspected by ______Date ______

Comments ______

______