Permission to Lodge Application Form
Under Clauses 84, 49(1)(b) and 126 of the Environmental Planning and Assessment Regulations 2000
You can use this form to obtain landowners consent to lodge:
• a Development Application
• an application to modify a Development Consent (Section 96 Application)
• an application for a Complying Development Certificate
•
•
•
an application to modify a Project Application under Section 75W of the Environmental Planning and Assessment Act 1979
a State Significant Development Application
an application to modify a State Significant Development Application.
HOW TO COMPLETE THIS FORM
1:
2:
3:
4:
Ensure that all fields have been filled out correctly.
Please answer all questions marked with an * before submitting the application.
Once completed you will need to print out and sign this form.
You can submit this form by mail or in person:
By mail:
Roads and Maritime Services
PO Box 973
Parramatta CBD
NSW 2124
Or in person:
Roads and Maritime Services
27-31 Argyle Street
Parramatta
NSW 2124
(by appointment during business hours –
call 131 236)
This form must be read in conjunction with the Obtaining Permission to Lodge Policy. This policy and other
relevant information can be found on our website.
This form is a public record and may be made available on the Roads and Maritime website.
PART 1 – DETAILS OF THE SITE
Name of Bay or Waterway: (if wholly or partially located in/over water)
Postcode: *
Suburb: *
Property benefiting from the proposed development
Street number: *
Street name: *
Lot number:*
DP/SP:*
Title reference (eg Vol/Fol):
Note: The property benefiting from the proposed development is generally the property which intends to make use of the proposed
development, or on which any associated facilities (eg, car parking) are located. For further details or clarification please email
the Maritime Management Team, Roads and Maritime Services (Maritime) at [email protected]. If
there is more than one site please attach details of other sites.
Application Form - Permission to Lodge Catalogue No. 45065531 Form No. 5409 (07/2016) ABN 76 236 371 088
Page 1 of 6
PART 2 – DETAILS OF THE DEVELOPMENT APPLICATION/PROJECT APPLICATION
Type of application: (Please tick appropriate box below)
Development Application ($415 Application Fee)
Application to modify a development consent (Section 96 Application) ($415 Application Fee)
Complying Development Certificate ($250 Application Fee)
An Application to modify a Project Application ($415 Application Fee)
State Significant Development ($415 Application Fee)
An application to modify a State Significant Development ($415 Application Fee)
Consent authority for the proposed application:*
Description of the proposed development:*
Note: A statement is also required to provide a detailed description of the proposed development, including access arrangements (see
Note 1). Sufficient information must be provided on the precise location of the land to which this application relates and the
nature and extent of the development for which consent is ultimately sought.
Is the proposed development considered to be minor development?* (See Note 2)
Yes
No
Existing use of site:*
Location of proposed development (if part of an existing structure or facility:
PART 3 – APPLICANT DETAILS
The applicant seeking Permission to Lodge must be the owner of the property abutting the proposed development site. If there is
more than one owner - all owners must sign.
Title:
Given name/s: *
Family name: *
Organisation / company name (if applicable):
Postcode: *
Address: *
Home number: *
Mobile number: *
Fax number: *
Email address: *
Business number:
Applicant name (please print):
Note: If you are signing on behalf of a company please state position:
Applicant signature: *
Date: *
Note: It is important that we are able to contact you if we need more information. Please give as much detail as necessary.
Application Form - Permission to Lodge Catalogue No. 45065531 Form No. 5409 (07/2016) ABN 76 236 371 088
Page 2 of 6
PART 4 – LESSEE DETAILS (See Note 3)
Note: The Lessee is the person/s or party who intends to have a formal tenure agreement over the site with Roads and Maritime in
relation to the proposal.
Title:
Given name/s: *
Family name: *
Organisation / company name:* (if applicable):
ACN / ABN * (if applicable):
Address: *
Postcode: *
Home number:
Mobile number:
Fax number:
Email address:
Business number:
Existing tenure arrangements (See Note 4)
Do you already have an agreed tenure arrangement with Roads and Maritime over any part of the site of the proposed development?*
Yes
No
If yes, you must provide the following information:
Lease/agreement number:
Date rent paid until:
Are you aware of any other tenure arrangement with Roads and Maritime which applies to any part
of the site of the proposed development?*
Yes
No
If yes, please provide details:
Lessee signature(s)
I/We agree to enter into an appropriate tenure arrangement that is acceptable to Roads and Maritime for this development prior to the
commencement of any works on land owned by Roads and Maritime (See Note 4).
I/We consent to this application being made on my/our behalf (please cross out if the Lessee is also the Applicant).
Lessee name: * (please print)
Company/Strata Stamp/Seal to
be affixed if applicable:
Position:
Signature: *
Date: *
Lessee name: * (please print)
Position:
Signature: *
Date: *
Application Form - Permission to Lodge Catalogue No. 45065531 Form No. 5409 (07/2016) ABN 76 236 371 088
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PART 5 – OWNER OF ABUTTING LAND (See Note 5)
Is the proposal located either wholly or partially on/over submerged land (ie. below the mean high watermark)? *
Yes
No
Yes
No
If no, go to Part 6
Does the lessee or lessees noted in Part 4 own all abutting land located landward of the subject site?*
If yes, go to Part 6
If no, please provide details of this land:
Street number:
Street name:
Lot number:*
DP/SP:*
Title reference (eg Vol/Fol):
Please also attach a written statement from the owner/s of this land consenting to the making of this Application.
PART 6 – CHECKLIST*
The following information is required for every application in digital and hard copy/printed format. All digital information should be
contained on one USB.
Please tick all applicable boxes below which relate to documents you intend to lodge with this application.
Provided
1:
Completed application form
2:
Lessee details and consent
Part 4 of this form must be completed (and any other applicable information specified in
Note 3 must be attached)
3:
Consent from owner/s of abutting land
A written statement is required from the owner/s of abutting land (if not the lessee)
4:
Plans (1 copy)
See Note 6 for further information
5:
Statement (1 copy)
See Note 1 for further information
6:
USB containing a digital copy of the CAD of proposal (see Note 7 and Note 8)
A USB must be provided containing a pdf copy of all documents attached to this application.
This should include a scanned copy of this application form. Note that a CD or similar media
will not be accepted. See Note 7 for more information on digital file requirements.
7:
Fee
Please refer to fee schedule in Part 2 (page 2 of this application form)
Note: All Cheques are to be made payable to "Roads and Maritime Services" (no acronyms)
For credit card payment, please refer to Roads and Maritime website.
Not provided
PART 7 – APPLICANT DECLARATION *
Important Notice
Roads and Maritime Services will not process applications that are incomplete or do not comply with lodgement requirements. These
will be returned to applicants if Roads and Maritime is unable to assess the application. Roads and Maritime can request additional
information from applicants to allow proper assessment if all requirements have not been met.
Check fee calculation on page 2 (Part 2) prior to lodgement.
• I apply for permission to lodge an application described above. I declare that all the information in the application and checklist is to
the best of my knowledge, true and correct.
• I also understand that if the information is incomplete, the application may be delayed or rejected or more information may be
requested. I acknowledge that if the information provided is misleading, any approval granted may be void.
• I declare that the digital data provided is a true copy of all plans and associated documents submitted with this development
application.
Application Form - Permission to Lodge Catalogue No. 45065531 Form No. 5409 (07/2016) ABN 76 236 371 088
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PART 7 – APPLICANT DECLARATION * - Continued
• I declare that the digital data is not corrupted and does not contain any viruses.
• I understand that the information and materials provided will be made available to the public in accordance with the requirements of
the Government Information (Public Access) Act 2009, or other relevant policy.
• Details of this application and its determination, including parts of this application form, any attachments and/or plans, and any
navigation assessment, may be published on the Roads and Maritime Services website.
• I understand that, should Roads and Maritime decide to grant Permission to Lodge, that permission will be granted only to a
development of that nature, extend and specific location. Permission to Lodge cannot be transferred to another lessee or Applicant.
Subsequent modifications to the nature, extent or precise location of the development may result in Roads and Maritime requiring
that the applicant reapply for land owner's consent in relation to any land or development not covered by the original consent.
• I understand that, further to any requirements under the Environmental Planning and Assessment Act 1979, I will also be required to
have an appropriate tenure arrangement with Roads and Maritime before any construction can take place.
• I understand that, if the subsequent planning application is substantially different from what is set out in this application, Roads and
Maritime may refuse to enter into a tenure agreement to facilitate the development.
Applicant name * (please print):
Signature: *
Date: *
NOTES ON COMPLETING THIS FORM
Note 1
The statement can be in the form of a brief letter outlining the proposal. If you need to attach consent from the owner/s of
abutting land (see Part 5) it is important to clearly set out any relevant access arrangements.
For the purpose of determining land owner’s consent applications only, it will not generally be necessary for Roads and
Maritime to be furnished with financial documents or documents which assess the impacts of development (such as a
Statement Of Environmental Effects). It may however be helpful to identify the relevant zoning to identify whether the
proposal is permissible.
Before lodging your application it is recommended that you first contact the relevant consent authority to discuss whether
the proposal is likely to be approved.
Note 2
‘Minor development’ is that listed as such under Schedule 3 of the Sydney Regional Environmental Plan (Sydney Harbour
Catchment) 2005. Permission to Lodge applications which relate to minor development will generally be decided by Roads
and Maritime within 30 days of acceptance of a complete application.
For all other Permission to Lodge applications (and where feasible), Roads and Maritime will generally assess and
determine whether to grant land owners consent within 60 days of acceptance of a complete application.
Note 3
A. Roads and Maritime will only grant permission to lodge a planning application to the Applicant/s noted in Part 3 of this form.
B. Where publicly-owned land (as vested in Roads and Maritime) is used to accommodate development, the NSW
Government, on behalf of the community, is entitled to charge rent for the use of this land. Permission to Lodge will
generally only be granted by Roads and Maritime if the application relates to land which is the subject of a lease, licence
or similar tenure arrangement.
C. Potential lessees who are companies can indicate consent by signing under seal or as otherwise authorised under
Corporations Law. Alternatively potential lessees who are companies can indicate consent by meeting the following criteria:
i)
ABN or ACN number must be provided and:
ii)
Name, position and signature of: – one company director and company secretary; or – two company directors;
or – if a sole director company, only one signature is required.
D. Individual lessees must sign and print their names. Where there is more than one lessee, all lessees must sign.
E. Consent and seal of the owners corporation is required if the site is proposed to be leased by an Owners Corporation.
The Strata Managing Agent or two (2) members of the Owners Corporation must sign.
F. Where a development is proposed to be shared, both future lessees must sign.
G. A person acting under registered Power of Attorney must quote book and page number, and provide a full copy of the
Power of Attorney.
Application Form - Permission to Lodge Catalogue No. 45065531 Form No. 5409 (07/2016) ABN 76 236 371 088
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NOTES ON COMPLETING THIS FORM – Continued
Note 4
Note that, a new tenure arrangement will be required in most circumstances. If you have an existing tenure arrangement
with Roads and Maritime this may be sufficient however you are still required to agree to the creation of a new tenure
arrangement should Roads and Maritime deem it necessary.
For details on an existing tenure arrangement please contact a Roads and Maritime Property Officer via email:
[email protected] and quote the address of your property. Note that Roads and Maritime will not
consider any applications for Permission to Lodge where there is any outstanding rent payable or any other non-compliance
with an essential condition of the lease. You should contact the Property Officer in the first instance to confirm these details
prior to lodging this application.
Development proposed on Roads and Maritime submerged lands must have a functional relationship to the use of the
adjacent dry or reclaimed land.
Note 5
If the lessee/s (as identified in Part 4 of this form) do not own the land abutting the site then this section must be filled out.
The requirements contained in Note 3 relating to companies and owners corporation also apply to any written consents
provided under this Note.
Note that where a proposed development adjoins a boundary, the consent of both owners is required in writing (eg. a
shared sea wall). If there is more than one other adjoining site please attach details of this land.
Note 6
A. An existing site plan must be provided which includes:
i)
title block, border, scale, key, boundary dimensions, site area, north point and, where applicable, vertical datum
and contours;
ii)
location and use of existing structures;
iii) the position of the Roads and Maritime title boundary, being Mean High Water Mark, Former Mean High Water
Mark or other cadastral boundary where relevant;
iv) existing levels of the site in relation the Zero Fort Denison Tide Gauge (or the local hydrographic datum in locations
outside Sydney Harbour) including the height of any seawalls and the like; and
v)
boundaries of the adjoining land and relevant Divisions of Waterway.
B. Plans or drawings describing the proposed development must be provided which indicate:
i)
title block, border, scale, key, boundary dimensions, and north point;
ii)
the location of proposed development (including extensions or additions to existing structures) in relation to the site
boundaries and adjoining development.
iii) elevations and sections showing proposed materials, external finishes and heights (and outline any existing
structures);
iv) proposed finished levels of the proposed structures and/or land in relation to the Zero Fort Denison Tide Gauge
(or the local hydrographic datum in locations outside Sydney Harbour).
C. Plans should be drawn with clarity and to an appropriate scale as shown on the plans. All plans should be consistent
with each other. Plans showing the site and proposal can be combined if appropriate, however should legibly show all
the required information.
Note 7
For all proposals other than Minor development (see Note 2), you must provide a digital file of the site plan (see note 6A)
as a DWG, DXF or ESRI shapefile, georeferenced in MGA Zone 56 coordinates. To assist you in preparing this digital plan,
Roads and Maritime can supply the Applicant with a current digital plan of the site. To request a digital plan of the site
please email your request to: [email protected]. Please note that Roads and Maritime will only supply
this data to the future Applicant.
Note 8
A copy of all written documents and plans must be provided in PDF format.
Application Form - Permission to Lodge Catalogue No. 45065531 Form No. 5409 (07/2016) ABN 76 236 371 088
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