Application for Certificate of Approval of Public Building (Form 2)

Application for Certificate of Approval of Public Building (Form 2)

Health Act (Miscellaneous Provisions) 1911

Health (Public Buildings) Regulations 1992 (Reg.5)

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Team Name
Premises Details
Name of Public Building
Address of Premises
Nearest cross street
Construction / extension / alteration of which was completed on

DayMonthYear
Date
In accordance with your approval given on

DayMonthYear
Date
Applicant Details
Name of Owner/Agent
Address
Suburb
Phone
Mobile
Format: 0000 000 000.
Email
example@example.com
Owner / Agent Signature
Date

DayMonthYear
Should be Empty:

Premises Details