APPLICATION FORMS

 
We are attempting to provide as many as possible of the forms used to make applications to Council. Most forms on this page are in PDF format, which you can print off and post back to Council. In some cases, where no signature or payment is required, you can fill out an online application form. Where fees are chargeable please remember that the application is incomplete until such time as payment has been made to the Council.

If you experience difficulty downloading and opening any of these forms it may be because your Adobe Acrobat Reader is an older version. Please click on the logo to download the latest reader.

 
Please select from one of the following options:
 
Amusement Devices
Animal Control
Building Consents
Cemeteries
Clutha Country Brand Use
Community Directory
Employment
Food Hygiene
Funding Schemes and Grants
Ground Hire
Hall Hire
Land Information Memorandum
 
 
Libraries
LIMS Council is unable to process urgent LIM applications between 19 December and 9 January.
Liquor Licensing
Mahinerangi Environmental Enhancement Fund
Premises Registration
Project Information Memorandum
Rates (Direct Debit Authority)
Resource Consents
Roading
Rural Fire
Sewerage
Water
 

 
Amusement Devices
 
Application for a permit to operate an amusement device
 
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Animal Control
 
Dog Registration Application 2014/15
More than Two Dogs Licence Application
Information for Dog Owners Brochure
Dog Noise Information Brochure
Responsible Owner Application Form
 
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Building Consents
 

Application forms

Checklists/Information

 
Building Consent Application Packs (including checklists) for:
Solid Fuel Burning Space Heater
Deck Construction
Accessory Building Construction - garage or other non-habitable building
New House Construction
Commercial Buildings
 
Individual Application Forms
Application for Certificate of Acceptance

Application for a Certificate for Public Use

Application for Amendment/Variation to Building Consent

Application for Amendment to Compliance Schedule

Application for Building Consent/PIM (2013)

Application for Building Consent/PIM (editable PDF)

Application for Building Consent to Erect a Marquee

Application for Building Consent on Land that is Subject, or likely to be Subject to a Natural Hazard (Section 72)

Application for Code Compliance Certificate - scope of completion

Application for Alternative Solution

 

Application for Building Consent Exemption

 

Waiver/Modification Application and Record

Building Consent - Durability Modification Application

 

Notification of Change of Use of a Building

Notification of Building Work - Owner Decided Exemptions

Notification of Licensed Building Practitioner

 

Producer Statement Construction

Producer Statement Construction (Plumbing)

Producer Statement (Septic Tanks)

 

Statutory Declaration as to Owner-Builder Status

 

Means of Compliance Sheet

Compliance Schedule Details

 
Checklist - Commercial & Industrial Buildings
Checklist - Conservatories
Checklist - Construction of a Timber Deck
Checklist - Demolition Removal Consents
Checklist - Drainage
Checklist - Farm Buildings
Checklist - Garages, Carports and Sheds
Checklist - New Dwellings/Alterations to Dwellings
Checklist - Relocated Buildings
Checklist - Marquees
Checklist - Solid Fuel Burner
Checklist - Liquid Fuel Burner
 
Building Consent Fees & Charges (from 1 July 2014)
 
Southern Building Control Group Consents Advice Sheet

Overview of the Building Consent Process
 
Guide to Building Code Clauses
Clauses
Guide to Building Consent Applications
Guide to Certificate of Acceptance
Guide to Smoke Alarms
LPG in the Home
Regional Council Air Plan implications
 
Septic Tank Design Guide
 
DBH Restricted Building Work Information
 
For information on approved wood burners, please visit the Ministry for the Environment website by clicking here.
 
Subdivisions - A guide for applicants brochure
 
Brochure - Relocating a Dwelling
 
A beginner's guide to resource and building consent processes (Ministry for the Environment and Department of Building and Housing)
 

Building Act publications, including exempt building work and other guidance:

http://www.dbh.govt.nz/publications-about-the-building-act-2004

 
 
 

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Cemeteries
 

Application for allocation of plot or to reopen grave (PDF, 19kb, opens new window)

Council Fees & Charges 2014/15 (Council Cemetery fees on p.5. PDF, 492kb, opens new window)

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Clutha Country Brand Usage
 
Clutha Country brand use online application form
Clutha Country brand use application form (PDF)

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Community Directory

Online Community Directory alteration/new listing form

Community Directory alteration/new listing form (pdf)

 


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Employment

Job Application Form (PDF)
Application for Employment Form (MS Word, 227kb, opens new window)
 

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Food Hygiene
 

Application forms

Newsletters

 
Market Registration Application
Registered Premises
Application form for food sales by Voluntary Organisations [Apply on line]
Application form for food sales by Voluntary Organisations [pdf version]
 

 

Template documents

Pamphlets

 
Approved Suppliers sheet [pdf version]
Approved Suppliers sheet [word version]
Checking Food is Cooked sheet [pdf version]
Checking Food is Cooked sheet [word version]
Cleaning Schedules [pdf version]
Cleaning Schedules [Word version]
Cooling hot prepared food [pdf version]
Cooling hot prepared food [word version]
Diary sheet [pdf version]
Diary sheet [word version]
FCP Manager Training Record sheet [pdf version]
FCP Manager Training Record sheet [pdf version]
Four-week Review sheet [pdf version]
Four-week Review sheet [word version]
Pest control chart (pdf version)

Pest control chart (Word version)

Planned Maintenance [pdf version]
Planned Maintenance [Word Version]
Sickness Monitoring form [pdf version]
Sickness Monitoring form [word version]
Sickness Policy [pdf version]
Sickness Policy [
word version]

Sickness Template background [pdf version]
Sickness Template background [word version]
Staff FCP Training Record sheet [pdf version]
Staff FCP Training Record sheet [word version]
Staff Sickness Record Sheet [pdf version]
Staff Sickness Record Sheet [word version]
Staff Training Record Sheet [pdf version]
Staff Training Record Sheet [word version]
Temperature Monitoring form (pdf version)
Temperature Monitoring
form (word file)
Thermometer Calibration chart [pdf version]
Thermometer Calibration chart [word version]
Time Temperature Settings [pdf version]
Time Temperature Settings [word version]
Training Monitoring form [pdf version]
Training Monitoring form [
word version]
Transporting Food sheet [pdf version]
Transporting Food sheet [word version]
Unplanned Maintenance sheet [pdf version]
Unplanned Maintenance sheet [word version]
 

 

Advice for Home Caterers
Barbeques and Sausage Sizzles
Buffets & high risk foods
Farmers Market Guidelines
Fresh meat sales at Markets
Guide to Hangi
Home Catering
Homestay Advice
Sale of home baked Cakes
Sale of Cheese Rolls
Sale of home made Jams
Sale of Sweets & other Confectionery

Starting a Food Business
 

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Funding Schemes and Grants
 
Creative Communities NZ Funding Application 2014/15 (PDF)
 
Application for Council Reimbursement (PDF, 19kb, opens new window)
 
Telford A Division of Lincoln University Bursary Application & Information Form (PDF, 29kb, new window)
 

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Ground Hire Forms

Balclutha ground hire application (PDF, 36kb, opens new window)
Kaitangata ground hire application (PDF, 34kb, opens new window)
Milton ground hire application (PDF, 32kb, opens new window)
 

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Hall Hire Forms

Balclutha Memorial Hall Hire application (PDF, 36kb, opens new window)
Ex-Balclutha Borough Chambers Hire application (PDF, 25kb, opens new window)
Kaitangata Memorial Hall Hire application (PDF, 36kb, opens new window)
 

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Land Information Memorandum [LIM]
 
Application for LIM  Due to limited staffing levels during the Christmas period, Council is unable to process urgent LIM applications made between 19 December and 9 January. We apologise for any inconvenience.
 
Application for Property Condition Report
 

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Libraries
 

Adult Member Application Form

Youth Member Application Form

 

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Liquor Licensing
 
Liquor Licensing Fees
 
Application for On Licence or Renewal of On Licence
Application for New Off-Licence or Renewal of Off-Licence
Application for New Club Licence or Renewal of Club Licence
Special Licence Application Form
 
Manager's Certificate Application Form
Manager's Certificate Renewal Application Form
Notice of Management Change Form
 
If you require assistance please contact our Regulatory Department on 03 419 0200 during office hours.
 

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Mahinerangi Environmental Enhancement Fund
 

Fund Application Guidelines (PDF, 79kb, opens new window)

Fund Application Form (MS Word, 85kb, opens new window)

 


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Premises Registration
 
Registered Premises (Health Regulations)
Registered Premises (Local Government Act)
 

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Project Information Memorandum [PIM]
 

Application for Building Consent/PIM (2013)

Application for Building Consent/PIM (editable PDF)

 

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Rates
 
Direct Debit Authority Form (PDF, 1MB, opens new window)
 

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Resource Consents
 

Application Forms

Guides

 
Application for Resource Consent (Form 9)
Submission on an Application for Resource Consent
Written Approval of Affected Parties
Application for Section 139 Compliance Certificate
 

 

Guide to Assessment of Environmental Effects

Assessment of Environmental Effects - General

Assessment of Environmental Effects - Relocated Dwellings

Assessment of Environmental Effects - Signs

Assessment of Environmental Effects - Quarries

 

A beginner's guide to resource and building consent processes (Ministry for the Environment and Department of Building and Housing)
 
Brochure - Advertising Signs in the Clutha District
Brochure - Consultation with Iwi
Brochure - Relocating a Dwelling
 
 

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Roading

Application and policy for applying oil on roads (by Council or applicant)
Heavy Vehicle Impact Notice
Non-Spray Register Application Form 2012-14
 

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Rural Fire
 

From 1 July 2014, the Otago Rural Fire Authority will be taking over the responsibility for Rural Fire Permit issuing on behalf of the Councils.

 

The Otago Rural Fire Authority's contact details are 0800 OR-FIRE (0800 673 473).

 


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Sewerage

Sewer connection application form

 

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Water

Water connection application form

 

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Clutha District Council, 1 Rosebank Tce, PO Box 25, Balclutha 9240

P: 0800 801 350 | F: 03 418 3185 | E: help.desk@cluthadc.govt.nz

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