Application Form
Floodplain Advice and Information
Goulburn Broken Catchment Management Authority
Attention:
Date:
Floodplain Manager
Goulburn Broken Catchment
Management Authority
……/ ……/ …………
Address:
168 Welsford Street
SHEPPARTON 3630
Postal Address:
PO Box 1752
SHEPPARTON 3632
TAX INVOICE
ABN 89 184 039 725
T: (03) 5820 1100
F: (03) 5831 6254
E: planning@gbcma.vic.gov.au
Proposal:
……………………………………………………………………………………………………...…………………………
Applicant:
Mr/Mrs/Ms: ………………………………...…………………………………………………………………………….…
Company Name: ………………………………………………………………………….………………………………
Contact Phone No.: ………..…………………….…........ Fax No.: ………..…………………….…........
Return Postal Address: ………………………………………………………………………………………………...
Email: ……………………………………………………………………………………………….………………………
 Owner
Information
Requested by:
 Building Council
 Potential
Surveyor
 Consultant  Other
Purchaser
Property Details:
Must include ONE of the following:
Property Address (ie, 3 Kurrajong
Court, Homesview)
Crown Allotment and Parish Details
(ie, CA 12, Section D, Parish of
Homesview)
Lot Number and Plan of Subdivision
or Lodge Plan Number (ie, Lot 4 of
PS144333 or LP144333)
………………………………………..……
……………………………………………
……………………………………………
……………………………………..………
……………………………………………
……………………………………………
……………………………………………
……………………………………………
……………………………………………
Regional and local Locality Plans MUST be supplied with this Application
Refer Requirements on Reverse Side
Floodplain management information and advice is provided by the Goulburn Broken Catchment Management Authority pursuant
to powers under Division 4 of Part 10 of the Water Act 1989.
Payment Details:
To GOULBURN BROKEN CATCHMENT MANAGEMENT AUTHORITY regarding my payment of
$138 (including GST) for floodplain management advice and information (note, pensioners can apply
for 15% discount if a valid Pensioner Concession Card is presented in person or a photocopy supplied
with this application).
Please tick appropriate box:

I enclose a cheque/money order for $138.00 ($117.30 for
concession card holders) made payable to Goulburn Broken
Catchment Management Authority
 Payment by Cash
Note: do not send cash in the mail
Or:
Please charge my credit card:

Card No:
/
Valid from: …………………………………
Bankcard

Mastercard
/

Visa
/
Expiry date: …………………………
Cardholder’s name:
……………………………………
Address
………………………………………………………………… Postcode ………….
Signature of cardholder
…………………………………………………….
Please complete and send this entire application form to the Goulburn Broken Catchment Management Authority
with appropriate supporting documents – see fax number, postal and email addresses above
Lodgement of applications by email is preferred.
Information to be Provided by Applicants for
Floodplain Advice and Flood Information
The following information should be provided by the applicant, as applicable. This is a fairly thorough
checklist and not all items will be necessary for every application:
The minimum information to be provided is as follows:

Name and address of landowner;

Permit or reference number (if applicable);

Property description; including street address, parish name, CA No, Section No, Lot No, LP or
PS details;

Purpose of application, eg dwelling, subdivision, earthworks;

An accurate sketch showing location of proposal on property, eg dwelling, earthworks;

An accurate locality plan of the property, showing existing property boundaries (and proposed
subdivision boundaries if proposed); and

A regional locality plan to determine the property’s whereabouts within the catchment.
The following additional information may be required where applicable:

Existing and proposed use of the site;

The number of people expected on site during normal operations;

An accurate locality plan of the property
-
existing natural surface levels, including levels at the proposed building site and along
the access-way to the property boundary;
-
existing and proposed buildings, including floor levels;
-
existing and proposed earthworks, including finished surface levels, embankment
alignments and crest levels;
-
existing and proposed fencing;
-
existing and proposed road or access-way alignments and crest levels;
-
existing and proposed drainage systems, including waterways, pipelines, drains,
culverts and bridges;
-
other important physical features upstream and downstream of the property that may
affect flows, such as levee banks, fences and retaining walls.
Regional Locality Plan
Property
Location
Can be acopy
N of
Vicroads Directory
or CFA map.
N
Locality Plan
Subject
Property
This should show the
property boundaries as well
as adjacent properties and
several identifiable roads.
N
Sketch of Proposed Works
This should show a
reasonably accurate location
of the proposed works within
the subject property.
N