Please complete this form to apply for access to information not available on Council's website. If you need help in filling out this
form, please contact the Public Information Officer on (02) 4221 6111 or visit our website a
t www.shellharbour.nsw.gov.au
Applicant Details
Company (if relevant) ................................................................................................................................................
Title (Mr/Mrs/Ms) ........... Family Name ................................................. First Name/s ...............................................
Postal address ...................................................................................................................... Postcode ..................
Contact Number ............................................... Email ...........................................................................................
Details of Property
Application Number/s (ie DA/BA/CC) ............................. and/or Date Range ..........................................................
Unit/House Number ................................... Lot No ......................... DP ...............................................................
Street Name .............................................................. Suburb ...............................................................................
Details of Request
Development Application Information You can search for documents related to development applications by clicki
ng on Application Search in the Do It
Online section of Councils website. For information not available on Councils website please describe below.
................................................................................................................................................................................
................................................................................................................................................................................
................................................................................................................................................................................
Other Information (Please describe the information you would like to access in enough detail to allow us to identify it.)
................................................................................................................................................................................
................................................................................................................................................................................
................................................................................................................................................................................
Plans & Copyright - Plans and other copyright documents will only be made available for viewing at Council’s
administration building.
If you require copies (hard copy or email) you will need to gain written permission from the
copyright owner/architect. Their contact details will be provided to you upon request.
Owners Consent for Residential Floor plans
Copyright Holder/Architect's Consent
As the owner(s) of the above property, I/we give consent to
As the author/architect of the requested information, I give
release the internal floor plans.
consent for Council to provide copies to the applicant.
Owner's Name/s ...............................................................
Document Title:..................................................................
.........................................................................................
Architect/Author's Name ....................................................
Owner's Signature/s .........................................................
Company ..........................................................................
.........................................................................................
Signature ..........................................................................
Date .................................................................................
Date .................................................................................
Signature
Note: Please see the section on Fees & Charges overleaf that may apply to your request.
Applicant's signature .................................................................. Date ...................................................................
Last Updated Sept 2018
Page 1
Please submit completed application to:
In Person:
Council’s Administration Building
Shellharbour Civic Centre,
Post: The General Manager
76 Cygnet Avenue
Shellharbour City Council
Shellharbour City Centre
Locked Bag 155
SHELLHARBOUR CITY CENTRE 2529
Email:
xxxxxxx@xxxxxxxxxxxx.xxx.xxx.xx
IMPORTANT INFORMATION
Please Note: In accordance with S.8 of the GIPA Act Council cannot be required to disclose information pursuant to an informal
request and cannot be required to consider an informal request. Council can impose reasonable conditions with respect to the
release of information and can decide by what means the information is to be released. Public access to a record may be
facilitated by deleting any information if the inclusion of that information would otherwise result in there being an overriding
public interest against disclosure of the record.
Archived Files:
In processing a request for information it is sometimes necessary to
retrieve files from Council's offsite storage
facility. If these files are not accessed by the applicant within two weeks or if a prior arrangement has not been made to hold
these files, then they will be returned to archives. If the files are required after this time a new application will need to be
submitted.
PRIVACY & PERSONAL INFORMATION PROTECTION NOTICE
Purpose: The information on this form is being collected by Shellharbour City Council and supports your request for access to
information. Your personal information will be used by Council staff for the purpose of determining your request. The provision
of this information is voluntary; however without it Council may not be able to process your request. You may apply to Council
for access to this information.
Requests for Correction: Requests for correction of information under the Government Information (Public Access) Act or
Privacy & Personal Information Protection Act 1998, please contact the Council’s Public Information Officer.
Storage: This completed form will captured and stored in Council’s records management system.
Customer Service Use Only
Documents Provided .................................................................................................................................................................
.................................................................................................................................................................................................
Name ......................................................................................... Date ....................................................................................
ID sighted ..................................................................................................................................................................................
Completed? Y / N
Photocopying/CD Fees
No of pages
Cost
A4 B&W $2 1st page, $1 each additional page
(code 52)
A4 Colour $2 1st page, $2 each additional page
(code 52)
A3 B&W $3 1st page, $2 each additional page
(code 52)
A3 Colour $3 1st page, $3 each additional page
(code 52)
A1 Plans $12.00 per sheet
(code 58)
Plans per square metre $20.00
(code 58)
Documents on USB/DVD - $20 each
(code 007)
TOTAL:
$
Paid by
Cheque
EFT
Cash Receipt No. .............................. Date ......................................
General information about the GIPA Act is available by contacting the Information & Privacy Commission
freecall 1800 INFOCOM (1800 463 626) or web site at http://www.ipc.nsw.gov.au
Last Updated Sept 2018
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Document Outline
