Application for Excess Animals Permit
To Keep More Than The Permissible Number of:
Dogs

NAME:
Cats

Birds


Rabbits
......................................................................
(SURNAME)
Other …………………….
............................................................................
(OTHER NAMES)
ADDRESS: .........................................................................................................................................................
PHONE:
.............................................
(Business) ................................................
(After Hours)
Please list animals currently housed at your premises and those you are seeking a permit for.
Species & Breed
Total Number of Dog:
Animal
Name
Colour
S
e
x
Ster
Y/N
Microchip No.
................................... Total Number of Cats ...............................
By what method will these animals be controlled within the property? (i.e. fences, caging, etc)
..............................................................................................................................................................................
What is the purpose for which these animals are being kept?
..............................................................................................................................................................................
If you are keeping dogs/cats for the purpose of breeding, please supply Breeder’s Permit details.
..............................................................................................................................................................................
Signed:.............................................................................Dated:....................... ..................................................
Fee of $145 payable upon application lodgement
Written consent is to be obtained from the occupants of all properties immediately abutting the property
where the animal/s will be kept. Space is provided for consent details on the rear of this form.
_________________________________________________________________________________
Office use only A/C 2000.1246 $145.00
PAGE 1
The undersigned have no objection to a Permit being granted for the specified excess animals to
be housed at ........................................................................................................................................................
(ADDRESS)
which abuts the property at which we reside.
NAME
PAGE 2
ADDRESS
SIGNATURE
CONTACT
NO.