Form 1F: Supplementary Application Form for Work on a Heritage
Tree
Form to be filled out in conjunction with Form 1 Land Use Consent Application
PART A – DETAILS OF PROPOSED WORK
Please note that a report from a qualified arborist may be required, depending on the significance of the proposed works and the
effects.
Please tick the following which apply to your application:
 Removal or felling of the tree(s)
 Construct a building or lay underground services within 5m of the base of the tree(s)
 Lay paving within 0.5m of the tree(s)
 Prune the tree(s) at a height greater than one third the total height of the tree and/or branches greater than 50mm
in diameter below this level
a) Please state the Historic Trees Register number for each tree (from Appendix 6 – Grey District Plan):
b) Describe in detail the proposed works on the tree(s):
PART B - ASSESSMENT OF EFFECTS ON THE ENVIRONMENT (AEE)
a) What are the reasons for the proposed works?
Please note that the following items (b), (c) and (d) may be required to be endorsed by a qualified arborist.
b) What is the condition of the tree(s)?
c) Describe how trimming or disturbance of the root system of the tree(s) will affect the appearance and/or health of the tree(s)
d) Is the tree(s) likely to cause significant damage to buildings, services or property? If yes, please explain.
e) Is the tree(s) likely to cause obstruction to road visibility or constitute a road safety hazard? If yes, please explain
f) Have alternatives been considered to undertake the activity without the disturbance of the tree(s)?
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g) Is any substitute tree planting or landscaping proposed? If yes, please explain
PART C – ADDITIONAL INFOMATION
The provision of correct and accurate information will enable the effective processing of your application and will ensure that
delays are kept to a minimum.
Please provide the following information with your application:
•
Photographs of the tree(s)
•
A report from a qualified arborist if the works to the tree(s) are significant
CONTACT DETAILS
GREY DISTRICT COUNCIL
105 Tainui Street
PO Box 382, Greymouth
Phone: 03 769 8607 Fax: 03 769 8610 Email: planning@greydc.govt.nz
www.greydc.govt.nz
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