Landowner Consent Form | Yorke Peninsula Council elementORG

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Pre-requisite

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Have you watched the Land Owner Consent video?(Required)

View video here

Yes

Please ensure you view the Landowner Consent video prior to completing this form

Do you have the following documentation ready?(Required)

You need to confirm you have this ready prior to starting the application

Select exactly 5 choices.

Detailed Drawings

Funding Information

Site Plan

Quotes

Public Consultation outcomes

Organisation Details

Name of organisation:(Required)

Physical Address(Required)

Street Address Town Post Code

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Geocoder for physical address

Do you have a different postal address?(Required)

Yes

Postal Address(Required)

Address Town State Post Code

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Geocoder for postal address

Email Address

About your organisation and organisation objectives:(Required)

Project or Activity Overview

Project / Activity name(Required)

Project / Activity description(Required)

How did you decide the project / activity was needed?(Required)

Project / activity type(Required)

New

Upgrade

Project Address(Required)

Street Address Town Post Code

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Geocoder for project address

Address search for project location

Enter the approximate address of the location, then move the marker on the map to the exact location.

Project location map

Project location coordinates(Required)

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Geocoder

Note: Council as custodian maybe required to obtain further land owners consent from State Government

Who is the Project Manager?(Required)

Project Managers position in the organisation(Required)

Project Managers Phone Number(Required)

Project Managers Email Address(Required)

Project or Activity Detail

Have you met with a Council Officer about this project?(Required)

Yes

Please provide Officers name(Required)

What is the estimated project start date?(Required)

The start date must be at least 30 days into the future, to allow time for Council staff to review your application.

DD slash MM slash YYYY

What is the estimated project completion date?(Required)

DD slash MM slash YYYY

Council as custodian may be required to obtain further land owners consent from State Government.

Will the project create a new asset?(Required)

Yes

Do you intent to free-gift the completed project to Council?(Required)

Yes

Have you received quotations for the proposed project?(Required)

Yes

Please upload the quotations

Drop files here or

Max. file size: 128 MB.

Will the project be undertaken inside the footprint of your leased/licensed area?(Required)

Yes

Please provide more details regarding the location of the project(Required)

Will the project include alteration/upgrade to existing plumbing, fixtures or fittings?(Required)

Yes - internal only

Yes - external only

Yes - internal & external

Will the project include alteration/upgrade to existing electricity connections?(Required)

Yes - internal only

Yes - external only

Yes - internal & external

Will the project involve introducing new vegetation?(Required)

Yes

What type of vegetation are you introducing?(Required)

Has this project been endorsed by your organisation?(Required)

Yes

Please upload a copy of the minutes showing the endorsement(Required)

Drop files here or

Max. file size: 128 MB.

Have you carried out any public consultation with the community on this project?(Required)

Yes

Please provide details(Required)

Additional files(Required)

Please upload any additional files here - detailed drawings, site plans etc

Drop files here or

Max. file size: 128 MB.

Project / Activity Funding

What was the successful quote amount?(Required)

How much will your organisation be funding?(Required)

Did you receive a grant for this project?(Required)

Yes

What type of grant have you received?(Required)

Do you have any other funding sources?(Required)

Yes

Other funding types(Required)

Personal fund

Bank loan

Donation

Other

Other(Required)

How much other funding?(Required)

Total amount of funds(Required)

How will your organisation fund the on-going maintenance of the project?(Required)

Certification by applicant

Certification

I certify that I have been authorised to prepare and submit this application on behalf of the organisation and that the information contained is a true and correct record to the best of my knowledge.

I agree to the above certification

Name of President/Authorised Person(Required)

Signature(Required)