Request for Inspection of Premises Form

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Request for Inspection of Premises Form

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Request for Inspection of Premises Form
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Request for Inspection of Premises Form

Council Specific Information

All proprietors must sign this form.

Applicant Details

Name
Address(Required)
Postal address
If different to above

Premises Details

Address of premises to be inspected(Required)

Consent to Disclose Information

As the current proprietor/s, I/we consent to providing the applicant with the disclosure of any information and the publication of any documents in your possession or power relating to the said food premises, whether the information or the documents were obtained in connection with the administration of the Food Act 1984 and Public Health and Wellbeing Act 2008 or otherwise.
Proprietor 1 name
Proprietor 2 name
Clear Signature
Clear Signature
Proprietor 3 name
Clear Signature

Payment Details

Fees and Charges 2024/2025 – Pre-Purchase Inspection Report

Residential Tenancies (Caravan Parks and Movable Dwellings Registration and Standards) Regulations 2010 – (covered by Statutory Transfer of Registration Fee)

Food Act:  
Class 1 Premises$208.50
Class 2 Premises$212.00
Class 3a Premises$170.00
Class 3 Premises$133.00

Public Health and Wellbeing Act:  
Prescribed Accommodation $98.00
Personal Care and Body$79.50

Note: If a pre-purchase inspection report is requested in less than 7 days an additional fee of $25.00 applies.

Acknowledgement

Consent(Required)
Name of person completing this application(Required)
Clear Signature