Monash City Council

APPLICATION FOR REPORT AND CONSENT LAND LIABLE TO FLOODING – REGULATION 802 Building Act 1993 Building Interim Regulations 2017

Note: If all or any part of the proposed building footprint is within the SBO or LSIO overlay a Planning Permit is required. To: Monash City Council PROPERTY DETAILS No...... Street/Road...... ……….…..………

Suburb ...... …………...... Post Code ...... … If a Building Permit application has been lodged with a Building Surveyor that relates to the matter applied for in this application, please provide details of the Relevant Building Surveyor:

……………………………………………………………………………………………………………………… ……………………………………………… APPLICANT I, Owner  Agent of Owner  (Please tick one)

Name: ...... ………..……………………...... ……………...... Telephone: ...... Postal Address: ...... …...... Post Code ....…...... ……...... Email Address: ...... OWNER Name: ...... ………..……………………...... ………...... Telephone: ...... Postal Address: ...... …...... Post Code .....……...... …...... Email Address: ...... hereby give a copy of a building permit application/building design to Council and apply for a report and consent in accordance with Schedule 2 of the Building Act 1993 and Schedule 4 of the Building Interim Regulations 2017 for the following: Tick Reg Reporting Matter Fee @ July 2017 802 (2)(a) Building on land determined as being liable to flooding under the Water $ 262.10 Act 1989 802 (2)(b) Building on land identified in the Monash Planning Scheme as SBO/LSIO $ 262.10 802 (2)(c) Liable to flooding described on a Plan of Subdivision $ 262.10 802 (2)(d) Building on land designated by Council $ 262.10 THE PROPOSAL …………………………..….……………….….. ………...... ………………………………………………………………………………………………………….……………………. ………………..………..……………….. Signed ……………………………………...... ………...... Dated ……...... …...…….……

In order for your application to be assessed, this form must be accompanied by:  Two sets of plans for the work including a site plan and elevations and showing all finished floor levels and finished external surface levels. Note that levels to Australian Height Datum may be required.  A full copy of title including a plan and a copy of any covenants or agreements listed on the title.

APPLICATION FOR REPORT AND CONSENT LAND LIABLE TO FLOODING – REGULATION 802

SUBJECT PROPERTY ADDRESS:

PAYMENT OPTIONS:

In Person at: Mail – Cheque/Money Order: Email – Credit Card: 293 Springvale Road or PO Box 1 or mailto:[email protected] Glen Waverley Glen Waverley Vic 3150

I authorise the City of Monash to charge my Credit Card for Report & Consent Regulation 802(2) (b) and/or Regulation 802(2)(d) to:

MASTERCARD  VISA  AMERICAN EXPRESS  EXPIRY: /

NUMBER:    

NAME ON CARD: ______Signature: ______

Phone ______Total Amount: $ ______

Information Privacy The Privacy and Data Protection Act 2014 protects the personal information of individuals. The City of Monash takes this responsibility seriously and endeavours to manage and protect personal information in its possession at all times. The Council will only use and disclose information for the purpose/s for which it is collected.

The Council has adopted policies and procedures to protect personal information. These are available at Council’s web site www.monash.vic.gov.au. Queries regarding Council’s handling of information privacy can be directed to the Information Privacy Officer, Telephone 9518 3555.