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Place of Assembly Application Form
Use this form to apply for a permit to host a major event (over 1000 people) on council land.
Place of Assembly Permit Application
Use this form to apply for a permit to host a major event (over 1000 people) on council land.
I am applying as:
An Indivdual
A company or registered business
Applicant Name
First
Last
ABN/ACN
Date of Birth
MM slash DD slash YYYY
(for non-ABN/ACN holders)
Postal Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Business Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Contact person
Phone
Email
Role in Company
Relationship to the Business
Event details
Premises Trading Name
Event Name
Address of event
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Date/s of event
Proposed Start and Finish Time/s
Hours
:
Minutes
AM
PM
AM/PM
Description of Event and Activities
Maximum Number of People Attending at any one time
Including staff and volunteers
Number of Accessible Male and Female Toilets
Other Licenses Issued to the Premises
Emergency contact person
Name
Phone number
Supporting documents: Please tick the documentation included with this application
Event Site Plan
Approval from the Department of Health for a Smoke Free Event
Event Management Plan
Event Program (if applicable)
Noise Management Plan (if applicable)
Traffic Management Plan (if applicable)
Food Business Registration/s (if applicable)
Temporary Occupancy Permit (if applicable)
Application declaration
I declare that the information provided on this form is true and correct.
The personal information on this form is required by Clarence City Council for the Registration of a Place of Assembly under the Public Health Act 1997. We will only use your personal information for this and related purposes. If this information is not provided, council may not be able to process this application. You may access and/or amend your personal information at any time. How we use this information is explained in our Privacy Policy, which is available at www.ccc.tas.gov.au or at Council Chambers.
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