District Plan Form 5.

Submission on Proposed Plan Change or Variation to a Proposed Plan Change:

Note: If you plan to make a lengthy submission we recommend you type your submission in a word document that addresses the questions below, save a copy and attach it at the bottom of this form.

 

Name of District or Regional Plan:*
Plan Change Number:*
Name of Plan Change:*
Full name of submitter:*
Phone number of submitter:*	- - (eg 64 - 9 - 12345678)
Email address:*
Postal address:*	(Please note that your address is required to be made publicly available under the Resource Management Act 1991, as any further submission supporting or opposing this submission is required to be forwarded to you as well as the council)

(Please identify the specific parts of the Proposed Plan Change/Variation).

Rule(s): or
Property address: or
Map: or
Other - please specify: (maximum 500 words)

(Please indicate whether you support of oppose the specific provisions or wish to have them amended and the reasons for your views.) I support the spefific provisions identified above
I oppose the spefific provisions identified above  

I wish to have the provisions identified above amended: YesNo  

The reasons for my views are: (maximum of 500 words)

Accept the Plan Change/Variation
Accept the Plan Change/Variation with amendments as outlined below
Decline the Plan Change/Variation 

If the Plan Change/Variation is not declined, then amend it as outlined.
(maximum of 500 words)

I wish to be heard in support of my submission.*   YesNo

If others make a similar submission, I will consider presenting a joint case with them at a hearing. *   YesNo

I confirm that this submission does not contravene clause 6(3) or 6(4) of the First Schedule of the Resource Management Act 1991 (these are clauses referring to trade competition). *   YesNo

Submission Date:*

Attach file here: