APPLICATION TO CONSTRUCT, EXTEND OR ALTER A PUBLIC BUILDING Schedule 2 Form 1 Health (Public Buildings) Regulations 1992 – – I being the owner/agent hereby apply under Section 176 of the Health Act to construct, alter or extend a public building: PREMISES DETAILS: Name of Building/ Event: Address: Nearest Roads: Intended Use: In support of this application I hereby submit plans and details for: A Static Public Building e.g. school hall, craft room, church, pub etc. This Application must be □ accompanied by floor plans (to scale) of the building for your application to be processed. A Temporary Public Building (e.g. community fair, fete or temporary amusement structure). This □ Application must be accompanied by a site plan, the section overleaf completed and any additional information required by provided for your application to be processed. Owner/agent: Address: Phone: Email: Signature (signature by owner, occupier, manager, trustee or other person by whose authority such public building is intended to be built, created or converted thereto): For Further Information: Please contact the Shire’s Environmental Health Officer on 08 9821 9999. Disclaimer: This form is based on Form 1 in the Health (Public Buildings) Regulation 1992, for additional detail on the legislative requirement refer to the Health Act 1911 and Health (Public Buildings) Regulation 1992.
APPLICATION TO CONSTRUCT, EXTEND OR ALTER A PUBLIC BUILDING Schedule 2 – Form 1 – Health (Public Buildings) Regulations 1992 I being the owner/agent hereby apply under Section 176 of the Health Act to construct, alter or extend a public building: PREMISES DETAILS: Name of Building/ Event: Address: Nearest Roads: Intended Use: In support of this application I hereby submit plans and details for: □ A Static Public Building e.g. school hall, craft room, church, pub etc. This Application must be accompanied by floor plans (to scale) of the building for your application to be processed. □ A Temporary Public Building (e.g. community fair, fete or temporary amusement structure). This Application must be accompanied by a site plan, the section overleaf completed and any additional information required by provided for your application to be processed. Owner/agent: Address: Phone: Email: Signature (signature by owner, occupier, manager, trustee or other person by whose authority such public building is intended to be built, created or converted thereto): For Further Information: Please contact the Shire’s Environmental Health Officer on 08 9821 9999. Disclaimer: This form is based on Form 1 in the Health (Public Buildings) Regulation 1992, for additional detail on the legislative requirement refer to the Health Act 1911 and Health (Public Buildings) Regulation 1992.
Application_to_construct.docx