Caravan Parks and Camping Grounds Act 1995, sec. 7(1)(a)

APPLICATION FOR GRANT

OR RENEWAL OF LICENCE

To

Local government:

Facility name or proposed name

Applicant/s



[Each applicant to provide these details.]

Family name:

Other names:

Postal address

No.:

Street name:

Suburb:

Postcode:

Phone numbers (H):                         (W):

Fax number:         Email:

Land on which the facility is situated or is to be situated

Address:

or

Land description:

Land owner/s



[1. Only necessary if applicant does not own the land referred to above.



2. Details to be provided in respect of each land owner.]

Family name:

Other names:

Postal address

No.:

Street name:

Suburb:

Postcode:

Phone numbers (H):                         (W):

Fax number:         Email:

Declaration

[Making a false statement may be an offence]

I/We declare that all details in this form are true and correct.

Signature of applicant/s:

Date:

Documents to be attached



[Not necessary if application is for renewal of licence]

1.         The written approval of the owner of the land referred to in this form for the applicant/s to make this application, or proof that the applicant/s is/are the owner/s of that land.

2.         A plan of the proposed facility showing —

            (a)         the sites, and where applicable, denoting the types of sites;

            (b)         the buildings;

            (c)         the roads and paths;

            (d)         the drainage and waste water disposal systems; and

            (e)         the location of fire hoses, fire hydrants and extinguishers.

Only necessary for application for nature based park licence

3.         A management plan containing details about these matters in relation to the facility:

            (a)         market segment;

            (b)         the amenities that are proposed to be provided, or not provided, at the facility;

            (c)         site planning;

            (d)         environmental impact and sustainability;

            (e)         waste management;

            (f)         traffic management;

            (g)         risk management;

            (h)         length of stay of occupiers.

Caravan Parks and Camping Grounds Act 1995, sec. 7(4)

LICENCE

Expiry date

Local government

Name of local government:

Type of licence

Facility details

Name:

Address:

or

Land description:

Licence holder/s details

Family name:

Other names:

Postal address

No.:

Street name:

Suburb:

Postcode:

Phone numbers (H):                         (W):

Fax number:         Email:

Licence conditions

Conditions:

Special conditions to which section 13 of the Act applies:

Details of sites authorised

[Maximum number and type]

Overflow area details

Address or land description:

Details of sites [maximum number and type] :

Conditions:

Issued by:

Local government:

Date:

Caravan Parks and Camping Grounds Act 1995, sec. 23(3)

INFRINGEMENT NOTICE

Local government

Name of local government:

Alleged offender

Family name:

Other names:

Postal address

No.:

Street name:

Suburb:

Postcode:

Alleged offence

Section of the Act:

        or

Provision of the Regulations:

Description of alleged offence:

Where and when:

Amount of modified penalty

$

Authorised person who issued this notice

Name:

Signature:

Date:

WHAT YOU MUST DO

1.         You may dispose of this matter within 28 days after the service of this notice by paying the modified penalty.

OR

2.         Elect to have this matter dealt with before a COURT.

Should you not pursue one of the above options within the time specified above, additional administrative charges may be incurred and enforcement action may be taken under the Fines, Penalties and Infringement Notices Enforcement Act 1994 . Under that Act, some or all of the following action may be taken — your driver’s licence may be suspended, your vehicle licence may be suspended or cancelled, you may be disqualified from holding or obtaining a driver’s licence or vehicle licence, your vehicle may be immobilised or have its number plates removed, your details may be published on a website, your earnings or bank accounts may be garnished, and your property may be seized and sold.

Caravan Parks and Camping Grounds Act 1995, sec. 23(7)

WITHDRAWAL OF INFRINGEMENT

NOTICE

Local government

Name of local government:

To

[Details of alleged offender]

Family name:

Other names:

Postal address

No.:

Street name:

Suburb:

Postcode:

AN INFRINGEMENT NOTICE SERVED ON YOU HAS BEEN WITHDRAWN AND

ι         NO FURTHER ACTION WILL BE TAKEN*

ι         A SUMMONS WILL BE ISSUED*         [* delete whichever is not

        applicable]

Details of withdrawn notice

Date notice given:

Alleged notice:

Authorised person who issued this notice

Name:

Signature:

Date:

WESTERN AUSTRALIA

Caravan Parks & Camping Grounds Act 1995

IDENTITY CARD

AUTHORISED PERSON

[Photograph of authorised person]

This is to certify that ................................................ [name of person] .............................................. is an authorised person under section 17(1)(b) of the Caravan Parks and Camping Grounds Act 1995 .

        ............................................................         ...................................................................

        Signature         Date

Issued by the chief executive officer of the Department of Local Government, Sport and Cultural Industries.