PLANNING & ENVIRONMENT

Cnr of Queen Street and Broughton street

(PO Box 57) Campbelltown
Phone (02) 4645 4608 Fax (02) 4645 4111 DX5114

Notice to Council of Intention to commence work

Privacy Statement
The information requested by Council on this form may constitute personal information under the Privacy and Personal Information
Protection Act 1998. Council is allowed to collect the information from you to consider this matter. Supplying this information is
voluntary. However if you cannot or do not wish to provide the information, we may not be able to consider the matter. If you need
further details, please contact the Privacy Officer, Campbelltown City Council, cnr Queen and Broughton Streets, Campbelltown.

Notification to

Name: Campbelltown City Council

Street: Cnr Queen & Broughton St
Suburb: Campbelltown

Subject land

Lot:
Street:
Suburb:

DP:

Development Details:
Description of the building work or subdivision work

Development Consent (DC)

Construction Certificate (CC)
Complying Development Certificate (CDC)

DC Number:
Date DC Issued:
CC Number:
Date CC issued:
CDC Number:
Date CDC issued:

Principal Contractor
Owner Builder permit number ___________

Details of Principal Contractor/Owner

Builder:

Name:
Address:
Phone:
Email:

Fax:

Notice of Commencement
The building/subdivision work is intended to commence
on* (*Note: Not less than two business days from the date of the notice )

Date:

Details of person giving notice

Name:
Address:
Phone:
Email:
Signature/s:

(Owners Consent)

Compliance with conditions

(this statement must be completed for the Council
appointed as the PCA)

Fax:
Date:

I,
confirm that all conditions of the
above DC/CDC that are required to be satisfied prior to the
work commencing have been satisfied.

Further Enquiries: Please contact Councils Development Services Section (02) 4546 4608

Development Services
DocSet: 4183877

DATA AND DOCUMENT CONTROL

Revised Date: 17/02/2015
Review Date: 30/03/2017

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