Application Form for Health & Beauty Premises
NEW & ALTERATIONS
Contact Environmental Health Services t 9581 4573 f 9581 4500 e info@kingston.vic.gov.au
Note: Completed application and plan approval fee must be returned to this office at least 14 days prior to the
intended construction start date.
Section 1 – Health Premises
Trading Name:
Street Address:
Suburb:
Postcode:
Section 2 - Applicant Details
Applicant Name:
Mailing Address:
Suburb:
Postcode:
Contact No:
Email:
Section 3 - Proposed Proprietor Details
Applicant Name:
Mailing Address:
Suburb:
Postcode:
Contact No:
Email:
Section 4 – Agencies to Contact
Have you contacted Council’s Planning & Building department on 9581 4131 to determine if you require any
permits?
 Yes  No
If you require a footpath trading permit, see kingston.vic.gov.au/footpathtrading.
Did you know?
Council’s Economic Development team provides a range of support and services to all types of business in the City of
Kingston. You can find out more at kingston.vic.gov.au/business or phone 9581 4735.
Section 5 – Intended Activities
📎please attach
Please provide an explanatory paragraph detailing all activities you propose to conduct and type of business that you
will operate e.g. waxing, tattooing, hairdressing
Section 6 – Schedule of Finishes
📎please attach schedule of finishes
Please provide a schedule of finishes, including:

Description or specification for all finishes and claddings adhered to all internal surfaces in the premises,

e.g. wall, floor and ceiling finishes, bench top material
Description of all relevant furniture, fittings e.g. lights, ventilation and hands free basins

Description of relevant procedure equipment to be installed e.g. autoclave
Section 7 – Premises Plans
📎please attach premises plans
Please provide a premises floor plan which is to a scale of 1:100 (or greater) and clearly show the location of all:
 counters, cupboards and benches;
 instrument cleaning sinks, troughs, hair basins,
hand basins and kitchenette setup
 relevant equipment, ventilation and lighting;

area of rooms, walls, doors and openings; and
Section 8 – Qualifications and Experience
List all relevant qualifications or experience in area of business
Section 9 – Works Program
When will the works begin?
When will the works be completed?
Section 10 – Signature
Signature:
Date:
Position:
Please return this form to:
Environmental Health Services, City of Kingston
PO Box 1000
Mentone Vic 3194
t 9581 4573 f 9581 4500 e info@kingston.vic.gov.au
OFFICE USE ONLY
CASHIER
CODE
NPP
ACTIVITY
ACCOUNT NO
AMOUNT
G.S.T.
TOTAL
New Premises Plan
Processing
2002.1228
$154.55
$ 15.45
$170.00