Health Services Enquiries: 9217 2277
General Enquiries: 9217 2170
Health Services Fax: 9409 9863
Email: PublicHealth@whittlesea.vic.gov.au
TTY:(03) 133677 (ask for 9217 2170)
www.whittlesea.vic.gov.au
ABN 72 431 091 058
Civic Centre
25 Ferres Boulevard
SOUTH MORANG 3752
Locked Bag 1
BUNDOORA MDC 3083
Office Use Only
Application to submit plans
Public Health & Wellbeing Premises
Reference No:
Officer Initials:
Please note: Submitting plans to Council for approval is not a mandatory service for this
application. The service is provided to ensure your premises meets the Public Health &
Wellbeing Act requirements and to prevent costly alterations.
Receipt No:
Date Paid:
Date of application:
Applicant name:
Applicant description
Sole Proprietor
Partnership
Company
Architect/Draftsperson
Builder
Project Manager






Address of premises:
Postal address:
Contact numbers:
Bus:
Home:
Fax:
Email:
Mob:
Please complete the declaration below and sign the declaration
Please tick any of the categories listed below that are applicable to your business:
 Beauty therapy
 Business involving skin penetration
 Tattooing
 Hairdresser
 Colonic irrigation
 Other (specify)________________
Nature of works:
 New Premises
 Alterations to existing registered premises
Proposed trading name:
Opening Date:
Other council departments you must contact
Town Planning

Have you contacted town planning?

Do you require a town planning permit?
Building

Have you contacted building services?
Please attach a copy of your building permit
Yes 
Yes 
No 
No 
Ph: 9217 2236
Yes 
No 
Ph: 9217 2259
Declaration
I, the applicant (print full name)______________________________________ declare that I have contacted the above
Council departments regarding the permit requirements and the information contained in this application is true
Signature of Applicant:
Date:
Print Name:
Floor plan requirements: Please attach two copies of a detailed floor plan and specifications and submit with
the application form. The plan is to be drawn to scale of not less that 1:100 showing the proposed use of each
room.
Forms/Public Health & Wellbeing Act Application to Submit Plans
Reviewed June 2012
Fees
Please contact Council's Health Services to determine the appropriate fee and classification for your business or refer to
http://www.whittlesea.vic.gov.au
If paying by credit card via post, ensure you include a completed Credit Card Payment Authorisation form, which you can download
from the City of Whittlesea website.
Payment details
Language
Mail
Cheque/money order only, made payable to “City of Whittlesea”.
Mail payment and invoice to: City of Whittlesea, Locked bag 1 MDC,
Bundoora, 3083
In person
• Please present notice intact to the Cashier.
• Pay by cash, cheque, money order or EFTPOS (including credit card)
at the Civic Centre, 25 Ferres Boulevard, South Morang.
Bankcard, Visa card, Mastercard
Credit card
MasterCard or Visa
Telephone: 9217 2277
Office hours are 8.30am to 5.00pm Monday to Friday, except
Public Holidays
Privacy statement
Council is collecting the information on this form for the purpose of administration and enforcement of the Public Health and
Wellbeing Act 2008 (Vic). The information will be used solely by Council for the primary purpose or directly related purposes. As
required under the Public Health and Wellbeing Act 2008 (Vic), this information will be kept in a register (computerised database).
In accordance with the Public Health and Wellbeing Act 2008 (Vic) a copy of this information must be made available free of charge
to any person who requests it. You may access this information by contacting Health Services on 9217 2277.
Forms/Public Health & Wellbeing Act Application to Submit Plans
Reviewed June 2012