Application for Use of Council Controlled Parkland

Temporary Access for Private Works

placement of infrastructure within park or open space

Please read the enclosed Terms & Conditions prior to completing the application form to ensure correct form is being submitted, appropriate information is provided and you are aware of any bonds, permits and/or conditions that may apply to your usage. ALL DETAILS MUST BE COMPLETED IN ORDER FOR APPLICATION TO BE PROCESSED. A minimum of five (5) working days is required for processing park usage applications.
Applications for ‘major’ works should not be submitted on this form (refer to Park Usage Guidelines for appropriate application process).

Park Usage Details Park Name* or Location*
(Please provide street address. If location is obscure or a large parkland, please supply map showing proposed usage area) Start Date/Time*

[eg: 17/09/2009 03:45 PM] Finish Date/Time*

[eg: 17/09/2009 03:45 PM] Contact Details Name* Company* Postal address* Daytime Telephone* Mobile* Email* Are you the* Property Owner (resident)
Contractor appointed by Residential Property Owner
Developer
Contractor appointed by Developer
Other (please specify)
Temporary Park Access Please state reason access is required and the nature of works and/or development. Please be specific providing all details of work being undertaken including type/s of vehicle/s being used eg ute, truck, crane. Does your access require a park gate to be unlocked ?
YesNo

IMPORTANT NOTE/S:

A refundable bond is required to be paid for all Temporary Access Permits.
Application and/or usage fees may also apply (refer Items 3 & 4 of Terms & Conditions for Park Usage).
If an application fee is required, payment MUST be submitted with the application (cheque) or payment made at a GCCC
Customer Service Counter quoting Citipac A/C #98729, prior to application being processed.

AGREEMENT In checking this box and submitting this form, you acknowledge you have read and agree to abide by the terms & conditions enclosed with this form should approval be granted, and do hereby accept the terms & conditions contained therein. In doing so, it is acknowledged that Council’s decision in regard park access is final and failure to adhere to the terms & conditions may result in the approval being revoked.

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