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Office Use Only
Date Received
Application Fee
Receipt Number
Extension Approved
1 year / 2 year / Refused / Other
Responsible Officer
New Start Date
New Completion
Date
Application for Extension of Time to a Planning Permit
(Under Section 69 of the Planning & Environment Act 1987)
Extension of Time Request
Time requested:
One Year Two Years Others (please specify):
Commencement Expiry
Certification
Completion Expiry
Commencement & Completion Expiry
PLEASE NOTE
A permit holder may request an extension of time before or within 6
months after the commencement expiry date, where the use or
development allowed by the permit has not yet started; or within 12
months after the permit expiry date, where the development allowed
by the permit has lawfully started before the permit expires.
If the request is made out of time, Council cannot consider the request
and the permit holder will not be able to apply to VCAT for a review of
the matter.
Planning Permit Number
Planning Permit Number of
the permit to be extended:
Date of original permit issued:
__________________________________________________________
The Land
Current Address of the land
the planning application relates
to:
Previous Address (if applicable)
of the land the planning
application relates to:
Unit No: ____________ Street No: ____________ Lot: ____________
Street Name: ______________________________________________
Suburb: ______________________________ Post Code: ___________
Unit No: ____________ Street No: ____________ Lot: ____________
Street Name: ______________________________________________
Suburb: ______________________________ Post Code: ___________
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Applicant & Owner Name and Contact Details
The person you want Council
to communicate with about
the application.
Name: ____________________________________________
Organisation: _____________________________________________
Postal Address: ____________________________________________
____________________________ Postcode: _______
Phone No: ____________________________________________
Email: ____________________________________________
Fax: ____________________________________________
Owner’s Details (if not
applicant)
Name: _____________________________________________
Organisation: _____________________________________________
Postal Address: ____________________________________________
___________________________ Postcode: _______
Reason for the Extension Request
Why is the extension of time
required? (A reason must be
given)
Attach additional page if
required.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Have there been any previous extensions of time to this permit?
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
PLEASE NOTE
This section must be completed for Council to consider this request.
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Declaration by Owner or Occupier
This part must be completed by
the owner or occupier.
I consent to this application being made:
Name: __________________________________________________
Signature: _______________________________________________
Date:
PLEASE NOTE
Proof of ownership or occupancy may be required.
Declaration by Applicant
This part must be signed
I declare that all information in this application is true and correct:
Name: __________________________________________________
Signature: _______________________________________________
Date:
PLEASE NOTE
It is against the law to provide false or misleading information, which
could result in a fine.
Declaration by Owner or Occupier
Lodgement & Fee
Fee applicable:
Please contact Council for the correct fee or visit Council’s
website – www.ballarat.vic.gov.au
Lodge the completed and
signed form, appropriate fee
and any attached documents to:
Mail, including cheque (payable to the City of Ballarat)
PO Box 655
BALLARAT VIC 3353
In Person
25 Armstrong Street South, Ballarat
PLEASE NOTE
This application form must be completed in full and the application fee
must be paid prior to this request being lodged.
Statutory Planning
General Enquires: (03) 5320 5640
Email: info@ballarat.vic.gov.au
Website: www.ballarat.vic.gov.au
Privacy Notification
Your personal information is being collected by City of Ballarat for planning purposes in accordance
with the Planning and Environment Act 1987. Your information will be stored in Council’s Customer
Database and used to identify you when communicating with Council and for the delivery of services
and information. For further information on how your personal information is handled, refer to
Council’s Privacy Policy at www.ballarat.vic.gov.au