FORM 9
Section 88 and 145 of the Resource Management Act 1991
Type of consent being applied for.
Please tick
LAND USE SUBDIVISION
COMBINED LAND USE/SUBDIVISION
TIME EXTENSION
CHANGE / CANCELLATION OF CONDITIONS
OR CONSENT NOTICE CONDITIONS
OUTLINE PLAN / OUTLINE PLAN WAIVER
List the reasons for the application and any District Plan rules / standards infringed.
please print clearly
Please note: THIS IS NOT YOUR ASSESSMENT OF ENVIRONMENTAL EFFECTS (as required by the Schedule Four of the RMA) but it is important that you fill this section out clearly as consent cannot be granted for any activity that you do not apply for.
Describe the location as it is commonly known and in a way that will enable it to be easily identified e.g the street address, the legal description, the name of any relevant stream, river or other water body to which the application relates, proximity to any well-known landmark, the grid reference.
Property Address
Legal Description
Cross Lease / Unit Title
Legal Area
Other information relevant to location
LOT:
FLAT / UNIT:
DPS:
DPS:

Applicant
Postal
Address
Phone no.
include area code
Email
Address
Fax no.
include area code
Mobile no.
please print clearly
if different from applicant
Agent or Nominated
Contact name(s)
Postal
Address
Phone no.
include area code
Email
Address
Fax no.
include area code
Mobile no.
if different from applicant
Owner/
Occupier name(s)
Postal
Address
Phone no.
include area code
Email
Address
Fax no.
include area code
Mobile no.
All Correspondence (excluding invoices) sent to:
APPLICANT AGENT/NOMINATED CONTACT OWNER/OCCUPIER
Person Paying for this consent invoices will be sent to:
APPLICANT AGENT/NOMINATED CONTACT OWNER/OCCUPIER
YES
YES
YES
YES
NO
NO
NO
NO
Details or Consent No. if known
Details or Consent No. if known
Details or Consent No. if known
Details or Consent No. if known

Have you received pre-application information or had a pre-application meeting regarding this proposal from the Council? If YES, provide the name of the staff member(s)
Date of
Meeting
DD MM YYYY
Staff Member(s) name
YES NO
As landowner and with the consent of any occupiers or lessees, I agree to Council staff or authorised consultants visiting the site, which is the subject of this application, for the purpose of assessing this application.
If the applicant is not the land owner please provide the landowners or person authorised to sign on behalf of the landowner
Full
Name
Signature Date (DD/MM/YYYY)
Provide details of any entry restrictions or health and safety concerns that Council staff should be aware of; eg dogs, locked gates etc
Are you requesting the application to be publicly notified?
Are you requesting the application to be limited notified to any persons who you consider are likely to be adversely affected by your proposal (if the adverse effects on the person are minor or more than minor) and who have not provided their written approval?
Please note: it is at the discretion of council to determine who is adversely affected.
YES
YES
Please ensure you have attached the following when submitting this application
A completed and signed application form
A current Certificate of Title
(less than 3 months old)
Scaled Site Plan, Floor Plan, Elevations and any other relevant plans (2 copies)
An Assessment of Environmental Effects (AEE), in accordance with the Fourth Schedule of the
RMA 1991. Refer to the Planning Information
Sheet No. 4 on how to prepare an AEE.
The written approval of any Affected Person(s). Refer the Affected Person(s) Written
Approval Form (Form 8A).
Any other information required to allow this application to be adequately assessed against the relevant assessment criteria set out within the District Plan. You may wish to discuss these requirements with Council’s Duty Planner before lodging the application.
If an application for Subdivision, I attach information that is sufficient to adequately define:
• The position of all new boundaries; and
• The areas of all new allotments; and
• The locations and areas of new reserves to be created, including any esplanade reserves and esplanade strips; and
• The locations and areas of land below mean high water springs of the sea, or of any part of the bed of a river or lake, to be vested in the Crown or local authority under section
237A of the Resource Management Act 1991; and
• The locations and areas of land to be set aside as new roads.
Please note: Pursuant to section 88 of the RMA, the Council may reject the entire resource consent application if the basic supporting information has not been supplied or is found to be inadequate . Please refer to Planning Information Sheet No. 3 for details on resource consent information requirements.
NO
NO

The required deposit fee must be paid before any processing of the application will start
(refer to the schedule for Environmental Services Resource Consent Processing Fees)
I enclose a deposit fee of $ for the processing of this application.
I/we understand that Council may invoice me for the actual and reasonable costs incurred in the processing of this application. Subject to my/our rights under sections 357B and 358 of the RMA to object to any costs, I/we undertake to pay all and future processing costs incurred by the Council.
Without limiting the Council’s legal rights, if any steps, including the use of debt collectors, are necessary to recover unpaid processing costs, I/we agree to pay all costs of recovering those processing costs. If this application is made on behalf of a trust (private or family), a society (incorporated or unincorporated) or a company, in signing this application I/we are binding the trust, society or company to pay all the above costs and guaranteeing to pay all the above costs in my/our personal capacity.
Do you wish to see the draft conditions prior to the release of the resource consent decision?
If yes, Council may extend the processing timeframe pursuant to Section 37A of the Resource Management Act 1991.
YES
Applicant Full Name please print
NO
Signature of Applicant (or person authorised to sign on behalf of Applicant) Date (DD/MM/YYYY)
You may apply for 2 or more resource consents that are needed for the same activity on the same form.
If the application is lodged with the Environmental Protection Authority, you must lodge a form in Form 16a at the same time.
To: The Development Planning Manager
Thames-Coromandel District Council
Private Bag, 515 Mackay Street
Thames 3500
OR
To: The Environmental Protection Authority (“EPA”)
You must pay the charge payable to the resource consent authority for the resource consent application under the Resource Management Act
1991 (if any). If the application is to the Environmental Protection Authority, you may be required to pay actual and reasonable costs incurred in dealing with this matter (see Section 149ZD of the Resource Management Act 1991).
The information you have provided on this form is required so that your application can be processed under the RMA, so that statistics can be collected by the Council. The information will be stored on a public register, and held by the Council. The details may also be made available to the public on the Council’s website. These details are collected to inform the general public and community groups about all consents which have been issued through the Council. If you would like to request access to, or correction of your details, please contact the Council.
DATE & TIME RECEIVED RECEIPT NO.
DATAWORKS NO.
APPLICATION NO.
PROCESSING OFFICER