Application for a camping and temporary dwelling permit

Name*

First NameLast Name

Business name

Address*

Address

Address Line 2

SuburbState

Postcode

Email*

example@example.com

Contact number*

Location*

Start date and time for which permit is required*

Date

Hour MinutesAM/PM Option

End date and time for which permit is required*

Date

Hour MinutesAM/PM Option

CampingTemporary dwelling / caravan

TentCaravanOther

Size of caravan*

Reason for temporary dwelling or camping*

Please provide a detailed reason for your request

Number of campers*

Number of tents/ caravans / shelters*

YesNo

Where is the location of the public toilet?*

YesNo

How and where is the toilet being emptied? *

I acknowledgeNo house on-site

Where is waste water from cooking and handwashing being disposed?*

Smoke alarms must be installed and a fire blanket in the temporary dwelling/caravan. Please provide details of yours*

YesNoNot applicable

Please state a reason why a Building Permit has not been issued*

Please upload a copy of your certificate of currency for public liability insurance of a minimum of $20 million.*

Please provide a detailed and labelled site plan which also includes the distance from any adjoining property or dwelling, and the distance from any road below.

Please upload a detailed and labelled site plan of location of item/activity*

Include the distance from any adjoining property or dwelling, and the distance from any road below

Please provide supporting comments regarding the provided site plan above*

Please provide evidence showing that the occupation of the temporary dwelling is short term

e.g. a letter from a builder or housing authority detailing when a permanent residence will be available.

Please upload your completed neighbour support forms for all abutting neighbours*

Conditions

I am aware that if a permit is issued there will be conditions that I must adhere to.
Failure to fully provide the required information will result in my application being returned and a delay in processing.
The applicant understands that the personal information provided is to assess your application and record your permit and that he or she may apply to Council for access to and/or amendment of the information. Requests for access and or correction should be made to the Local Laws Department.
Failure to comply with any of the above conditions listed within the permit or on this application form could result in this permit being cancelled and/or penalties as prescribed in the Local Law

Temporary dwelling/ caravan

You must also provide details of how wastewater, sewerage and household waste is to be
disposed.
You must also provide evidence showing that the occupation of the temporary dwelling is short term. EG: a letter from a builder or housing authority detailing when a permanent residence will be available.
Smoke alarms must be installed and a fire blanket in the Temporary Dwelling/Caravan.
This application may be referred to other Council or External Departments before the
application is decided.
You must obtain signed neighbour consent forms from all your adjoining neighbours.

Application must include:

Completed application form
Application fee, which is non-refundable if permit refused
Site plan of location of item/activity
Neighbour Consent Forms
Certificate of Currency for Public Liability insurance of a minimum of $20 million

Please upload evidence showing that the occupation of the temporary dwelling is short term. *

E.g. a letter from a builder or housing authority detailing when a permanent residence will be available

Yes, I have all the completed consent formsI have some completed consent forms, the rest my neigbours will submit to Council directlyNo, I have not approached my neighbours for consentNo, I have provided the form to my neighbours for completion who will submit directly to Council

Neighbour Consent forms*

You must obtain consent from all your abutting neighbours before submitting your application. Download the neighbour consent form.

Site Plan showing placementCertificate of Currency for Public Liability insuranceNeighbour Consent formsEvidence showing occupation of temporary dwelling is short term

Camping

You must provide details of the type of camping that will occur. Eg: tent, swag
etc. You must provide the number of campers.
You must provide how many portable shelters will be set up.
You must also provide details of how wastewater, sewerage and household waste
is to be disposed.

Cheque – to be payable to Mitchell Shire Council – Post to 113 High Street, Broadford 3658Credit card or BPAY using the information provided on your tax invoice.In person – Cash, Cheque, EFT payments can be made at Council Customer and Library Service Centres

Collection of information

Personal information collected by Council is used for municipal purposes as specified in the Local Government Act, 2020 or other relevant legislation. The personal information will be used solely by Council for these purposes and or directly related purposes. Council may disclose this information to other organisations, if required by legislation.

The collection and handling of personal information is conducted in accordance with Council’s Privacy Policy. Please refer to Council's Privacy Statement and Privacy Policy on our website for further information about your rights.

I confirm that I have provided Mitchell Shire Council with true and accurate informationI understand my information is collected in line with Council's Council's Privacy Policy

Signature*

Source