Governance and Risk
(02) 4645 4320
Informal Release Application as per Government Information (Public Access) Act 2009 (NSW)
Privacy Statement
The information requested by Council on this form may constitute personal information under the
Privacy and Personal
Information Protection Act 1998 (NSW). Council is allowed to collect the information from you to consider this matter. Supplying
this information is voluntary. However if you cannot or do not wish to provide the information, we may not be able to consider the
matter. If you need further details, please contact the Privacy Officer, Campbelltown City Council, Cnr Queen and Broughton
Streets, Campbelltown.
Information provided to Council in correspondence, submissions or requests, including your personal information, may be made
publicly available, including on Council's website, under GIPAA. Please notify us if you object to the disclosure of your personal
information.
Please complete this form to apply for information held by Council under the
Government Information (Public
Access) Act 2009 (NSW) (GIPAA). If you need help in fil ing out this form, please contact Council’s Public Officer
on (02) 4645 4320, or visit our website at
www.campbelltown.nsw.gov.au.
1. Your details
Company Name (if applicable): ________________________________________________________
Surname: ______________________________ Other names: _______________________________
Postal address: _____________________________________________________________________
__________________________________________________________________________________
Contact number: ___________________________ Facsimile: _______________________________
Email: ____________________________________________________________________________
Are you seeking personal information? Yes / No (circle one)
If yes, the applicant must provide proof of identity in the form of certified copy. Only required when
applicant is requesting information on their own behalf.
Proof of Identity: ____________________________________________________________________
2. Type of information being requested (Please tick)
1. Information relating to a property
Street address: ______________________________________________________________________
___________________________________________________________________________________
Lot No: __________ DP or SP No: _____________ Application No: ____________________________
Description of Building:________________________________________________________________
______________________________ Approximate age of Building: ____________________________
Are you (or do you represent) the current owner of the above property? Yes / No (circle one)
If Yes, when was the property purchased? _____________________
If No, written consent may be required from the property owner for release of information.
DATA AND DOCUMENT CONTROL
Governance and Risk
Revised Date: 04/10/2016
Version: 3
DocSet: 5046031
Review Date: 30/12/2018
Page 1
Please specify the documents you are seeking access to: (please tick)
Development Applications
Home Warranty Insurance Documents
Building Applications
Plans (site, elevation, shadow, landscape, section)
Construction Certificates
Tree Inspection Consultation Reports
Occupation Certificates
Submissions received on development applications
Town Planner Report
Land Contamination Consultant Reports
Statement of Environmental Effects
Records of decisions on DA’s (including appeals)
Acoustics Consultation Reports
Applications for proposed developments
Structural Certification Documents
Heritage Consultant Reports
Other (please specify)
Please note:
1. Documents can be subject to Section 36 of the
Copyright Act 1968 (Cth) which protects copyright in relation to plans, technical
reports and documents and as such Council is unable to reproduce these documents without the express written permission of the
copyright owner. Where possible Council will try to supply details of the Copyright Owner so that you can obtain the necessary
permission.
2. Plans and specifications for any residential parts of a proposed building cannot be provided to third parties.
3. Depending on the age of the property, there may be a lack of documentation, and the documents that are available may be of poor
quality.
2. Other Information
Please describe the information you would like to access in enough detail to allow us to identify it.
(
Note: Depending on the scope and substance of the information being sought you may be asked to complete a
formal GIPA application.)
___________________________________________________________________________________
__________________________________________________________________________________
3. Penalty Infringement Photographs
Photograph of Infringement No: ______________________ / Registration No: ____________________
Prior to you being permitted access to this photograph you must provide Council with identification, e.g. Drivers
Licence, as well as proof of ownership of this vehicle.
3. Form of Access
How do you wish to access the information? (Please tick)
Electronic Copy by Email – Documents will be supplied via email.
Inspect the document(s) – Documents will be made available for inspection at Council.
A copy of the document(s) – Photocopying charges will apply. See fees’ & charges on Councils’ website.
6. Signature
Applicants Signature: ________________________________________ Date: ____________________
Council will process the application within 20 working days after receipt of a completed application.
This form can be lodged with Campbelltown City Council either:
In person:
Civic Centre, Cnr Queen & Broughton St, Campbelltown
By Post:
PO Box 57, Campbelltown NSW 2560
By Fax: (02) 4645 4387
Email:
xxxxxxx@xxxxxxxxxxxx.xxx.xxx.xx
Office Use Only:
Date application received: ________________________________________ Reference No.: ________________________________
Received by (Officer): ___________________________________________________________________________________________
DATA AND DOCUMENT CONTROL
Governance and Risk
Revised Date: 04/10/2016
Version: 3
DocSet: 5046031
Review Date: 30/12/2018
Page 2
