1 March 2006, Version 2

Plumbing and Drainage Act 2002 (ss. 85 & 86)

Application
Plumbing and for
Drainage Act 2002
Compliance Assessment 1
1. Type of application
To apply for a compliance permit or for a Compliance permit (go to Q2.)
compliance certificate where no permit has - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - -

been issued, complete Form 2 also. Compliance certificate. Has a compliance permit been issued? No Yes

Compliance Permit No. (If applicable) Date the work is proposed to commence

Is the application for compliance assessment of on-site sewerage work? No Yes

A relevant change is any change to the If Yes and a compliance permit has been granted - Has there been any relevant changes to the premises
premises (eg building work) which has since the granting of the compliance permit? No Yes (complete Q 7)
occurred since the compliance permit was
issued and that would change the information
included on the original application.
2. Related approvals Development Application No. Other
Provide the application number of other
approvals related to the work that is the subject
of this application.
3. 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

4. Applicant details Name (In full)

Clearly identify who is making the
application. The applicant need not be the
owner of the land. Signature Date
In signing and lodging this application, the
applicant is responsible for ensuring the
information provided is true. The local Contact person Phone No.
government will rely on this information
when assessing the application.
If the applicant is a company, a contact Mobile No. Fax No. Email address
person must be shown.
All correspondence will be mailed to this
address. Postal address

Postcode

5. Owner of the premises Name (In full) (Attach list if necessary)

The local government must give the owner of
the premises a copy of any compliance permit
or compliance certificate issued.
Postal address

Postcode

OFFICE USE ONLY

DATE RECEIVING REFERENCE
FEE ($)
RECEIVED OFFICER’S NAME/S NUMBER/S
6. Responsible person Name (In full)
The responsible person for regulated work is
a person who is licensed to perform the work
and either performs or directs the Plumbers Licence No. Drainers Licence No.
performance of the work.

The responsible person for on-site sewerage

work is a person who either performs or QBSA Licence No. (if applicable) Other Licence/Registration No.
directs the performance of the work.

If the responsible person for the work is not

known, the local government must be advised Phone No. Mobile No. Fax No.
who is the responsible person when
requesting an inspection.
Postal address

Postcode
7. Relevant changes-On-Site Sewerage Details of relevant changes section 18 (3) Standard Plumbing and Drainage Regulation 2003
A relevant change is any change to the
premises (eg building work) which has
occurred since the compliance permit was
issued and that would change the information
included on the original application.