City of Port Adelaide Enfield

SUPPORTED RESIDENTIAL FACILITIES ACT 1992 SECTION 24 (3) Requirement to furnish specific information (licence application) (Part 4)

TO: Name of the licence applicant

OF: Name of Applicant Address

WHEREAS you are the licence applicant of the supported residential facility known as……………… situated at ……………………………… Certificate of title: ……………..

TAKE NOTICE that additional information is required in your application for a licence.

Insert request details

ENVIRONMENTAL HEALTH OFFICER

RIGHT OF APPEAL

You may, within 28 days of the Notice being imposed, appeal against any of those requirements to the Administrative Appeals Division of the District Court pursuant to s32 (2) of the Supported Residential Facilities Act, 1992.