Application for Temporary Licence
Caravan Parks and Camping Grounds Act 1995, Caravan Parks and Camping Grounds Regulations 1997
Applicant Details
Name
First Name
Last Name
Address
Suburb
State
Postcode
Postal Address (if different from above)
Suburb
State
Postcode
Phone number
Email
Landowner/s
1. Only necessary if applicant does not own the land referred to above, 2. Details to be provided in respect of each landowner
Name
First Name
Last Name
Address
City
State
Postcode
Phone number
Email
Facility Details
Address on which the facility is to be situated
Address on which the facility is to be situated
Street Address Line 2
City
State / Province
Postal / Zip Code
Start date
/
Day
/
Month
Year
End date
/
Day
/
Month
Year
Number of sites requested
Site Plan
Please attach a site plan to this application detailing the following:
The location and type of sites (caravans, tents etc.)
The location of buildings and temporary facilities (including number of toilets, showers, bins etc.)
The location of roads and paths
The location and details of fire fighting equipment
The location and details of lighting
1. Site plan
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Declaration
I/We declare that that all the details in this form are true and correct
Signature
Date
/
Day
/
Month
Year
Please be advised that a fee of $100 is payable upon submission of this application
Submit
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