Club name

Date

Day

Month

Year

Site number

Site holder's name

Contact phone number

Club Committee Approval

*Office Use Only*

Name of Committee member

Position on Committee

Date

Day

Month

Year

Committee Signature

Signature field is empty.

Description of proposed works

The following information must be completed and submitted to your Club Committee to be considered for approval prior to works commencing. Please refer to the Club Development Standards to ensure the application complies with GMW requirements.

1. The Site

Site length (mm)

Site width (mm)

Total site area (m2)

Available area(m2) (maximum 2/3 of total area, up to 80mm)

Total site area covered by caravan, annex, eaves and veranda (m2)

2. CFA site separation and fire fighter access

Site boundary and structure clearance: (minimum 1200mm)

Clearance to structures on adjoining sites: (minimum 2000mm)

3. Concrete slab

3.1 Existing slab length(mm), width(mm) & area (m2)

3.2 Extension length(mm), width(mm) & area (m2) - if applicable

3.3 New slab length(mm), width(mm) & area (m2) - if applicable

4. Caravan

Length(mm), width(mm), height(mm) & area (m2)

5. Annex