Use of Hutt City Council Land Application

This application should be used alongside the Use of Hutt City Council Land Policy, and returned to Parks_Leases@huttcity.govt.nz. We collect the following personal information as required under the Reserves Act 1977, and/or Local Government Act 2002, so we can keep accurate records of concessions, and to communicate with you about your proposal.

• The applicant’s name

• The applicant’s address

• The applicant's contact and organisation details

This information will be held and shared internally with Hutt City Council. Your information will be stored in accordance with the Hutt City Council privacy policy.

Applicant's Details

Full Name of the property owner/organisation that proposes to use the land *Full Name of the property owner/organisation that proposes to use the land

Postal address *

Street address *

Suburb *

City *

Postcode *

Phone number *

Email Address *

Agent's Details (if applying on behalf of the Applicant)

Name

Phone number

Email Address

Land Details

Location (Address of HCC land that you would like to use and reserve name is applicable)

Legal description of land, if any.

Type of Land (Road Reserve/Drainage Reserve/Parks & Reserves etc) *

Purpose of use *

Type of Application *

New (first time application or existing concession has reached final expiration)Renewal (concession is still active, but due for renewal)

Type of use (Please mark the most appropriate) *

If Premise Lease or Grounds Lease were selected, please specify below *

Non-profit/charity purposes Commercial/for-profit

Term/Duration *

Temporary (up to 10 total days or up to 6 consecutive days within a calendar year)Short Term (up to 5 years) Long-Term (5 years+)

Permit Type (If Applicable)

Details of use *Describe your proposal below. Please provide a clear explanation as to why HCC land is being favoured over the use of private land. Please also attach to this application a list of any environmental positive and adverse (negative) effects of your proposal. This can be included in your Site Assessment.

Consultation *All affected parties are required to be consulted prior to applying to Council, this may be privately obtained from neighbours and/or publicly notified. Please list below the groups/property owners that have been consulted. * Under the Use of Council Land Policy, public notification may be required. *If the application is for the use of legal road, Council also requires written approval from utility service providers. If the proposed use affects the legal road frontage of another property, that property owner’s written consent is also required.

You must provide a copy of your plans (to metric scale) clearly showing the area you propose to use, site plans should be conducted by a professional. You will also need to include:

• Site Assessment/Outline Assessment of Environmental Effects your activity or occupation may have on the site or surrounding environment.

• An Operational Business Plan (financial planning) of your Club or Organisation

• An audited health and safety plan including a traffic management plan if relevant.

• If a resource or building consent is required or you are proposing a minor alteratio, please provide professional schematics.

Upload Field (You may upload multiple files) *

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Other Council Consents (Have any other consents relating to this proposal been sought from Hutt City Council?)

Subdivision Resource Consent Land use Resource Consent Building Act (Building Warrant of Fitness) Additional Vehicle Access or Heavy Vehicle Approval (Corridor Approval)

Have any other consents relating to this proposal been sought from Hutt City Council? If so, tick the appropriate box or boxes.

Signature *

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Date