SOLID FUEL HEATER COMPLIANCE CERTIFICATE

SOLID FUEL HEATER COMPLIANCE CERTIFICATE
(UNDER SECTION 68 PART F4 OF THE LOCAL GOVERNMENT ACT, 1993)
Note:
1. All details must be legibly printed or type written in ink.
2. Failure to complete the form & supply the required information will result in delays.

Privacy and personal information protection Notice: The personal information provided is collected for the purpose of processing this application. The development Application lodged by you (if applicable) or information contained therein may be provided to members of the public in accordance with the provisions of the Government Information (Public Access) Act 2009. Supply of personal information is legally required and failure to supply could cause delay in your application.
Name
Address
Suburb
Post Code
Contact No
Email
example@example.com
Address
Suburb
Post Code
Lot Sec DP
I hereby certify that the solid fuel heater modeltype
has been installed in the following premises by:
Name
Licence No
Application No
I certify the installation complies with the provisions of the current Australian Standards and manufacturer's installation instructions.
Name
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: