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Verification
of Covered Work 3
1. Prior approvals for the work Compliance Permit No. (If Applicable)
2. Description of land Street address (Include no., street, suburb/locality & postcode)
The description must identify all land the
subject of the application.
The lot & plan details (eg. SP / RP) are Postcode
shown on title documents or a rates notice.
Lot & plan details (Attach list if necessary)
If the plan is not registered by title, provide
previous lot and plan details.
Shop / tenancy No. (If applicable) Storey / level (If applicable) Local Government Area
3. Stage of Work Stage of the work covered and subject of the inspection request (tick one only)-
For plumbing and sanitary drainage laid under a floor slab or in another area where pipes or fittings
will be covered
For plumbing and sanitary drainage laid below ground level and external to a building or other
structure before backfilling
For a trench or sub-surface irrigation for on-site sewerage work – before filling
with backfill or after substantially filling with backfill but leaving a cross sectional
area not backfilled
For on-site sewerage work after all pipes are connected, and effluent resulting
from sewage generated on the premises can be treated by the on-site
sewage treatment plant
4. Inspection Arrangements When was the request for the inspection made?
Date Time
If there was an agreed time for the inspection, provide details below
Date Time
When was the work covered?
Date Time
Address
Postcode
Signature Date