Application for Constent to Erect a Building or Structure Over Authority's Drainage Easement

Please note: this form requires a fee of $290.40. This fee can be paid by credit card over the phone after the application has been submitted. Additional fees may apply in particular circumstances. Cash and cheque payments can be made in person by visiting the Borough of Queenscliffe, 50 Learmonth Street, Queenscliff.

For full conditions, please see the list at the bottom of this application.

Applicant details

If no, what are the owner's details?

Land details
Conditions and affirmation

The permit will be granted subject to the following conditions. The owner hereby agrees:

  1. To permit the Authority to enter into and upon the building or other structure and/or the easement for the purpose of inspecting constructing, maintaining or repairing any drain or other works of the Authority now laid or which may be hereinafter laid by the Authority and if necessary for that purpose to excavate through the floor of the said building or other structure.
  2. To be solely responsible for all injury, loss or damage which may be occasioned to the said building or other structure by reason of or incidental to the carrying out of the inspection construction, maintenance or repair of the said drain or other works of the Authority or by reason of or incidental to the presence of the said drain or other works of the Authority.
  3. To indemnify the Authority against all actions claims suits and demands arising out of or incidental to the erection and/or retention of the said building or other structure over the said easement.
  4. To pay to the Authority any additional coasts incurred by it in inspecting constructing, maintaining or repairing the said drain or other works of the Authority by reason of the said building or other structure having been erected over such drain or other works of the Authority and/or the said easement.
  5. Not to sell or mortgage land to which this consent refers without first disclosing the contents of this Consent to the purchaser or mortgagee.

In selecting the box below, you agree to the above conditions, and affirm that all details supplied in this application are true and correct to the best of my knowledge.

Being the owner of the land described in the Schedule hereto, hereby request consent to construct, erect and/or retain in the building and/or structure described in the Schedule hereto, over the easement of the Authority described in the said Schedule subject to the conditions set out below.

Privacy

Privacy Note: Council collects personal information to fulfil its statutory obligations, and to ensure that it can provide services to you. In some instances Council cannot provide some of its services unless you provide us with necessary information. Council will only use personal information for the purposes for which it was collected. Council staff are happy to discuss your privacy queries, however if you require further assistance you should contact our Privacy Officer on 5258 1377.