Proposal to register a health and wellbeing premises

Please complete and submit to propose registration of a premises under the Public Health & Wellbeing Act.

Fields marked with * are required

*Type of proposal

New premises
Alternation/s to a currently registered premises

Premises Details

Address of premises

Shop number

*Street number

*Street name

*Suburb name

*Business/mobile phone

Fax

*Email

Proposal details

Health Premises

*Type of Health Premises

Beauty Therapy
Hairdressing
Mobile Hairdressing
Tattooing
Body Piercing
Other skin penetration (that is: Myotherapy)
Electrolysis
Colonic Irrigation
Accommodation

Accommodation

*Please provide number of rooms

*Please provide number of guests

*Type of accommodation

Residential accommodation
Rooming house
Hostel
Student accommodation
Holiday camp
Motel/Hotel

*Please attach proposal plan of premises

Select files to upload (DOC,DOCX,PDF,JPG,GIF,XLS,XLSX,PPT,PPTX,TXT,RTX). File size limit 25MB

Applicant Details

Name of Applicant/s

Title

Mr
Mrs
Miss
Ms

*Full name

*Residential address

*Business/Company name

Business address

(if different from premises trading address)

*ABN number

Contact details

Phone

Mobile number

Fax

*Email

Terms and conditions

Council charges a commercial rate on land used for predominantly commercial activities (that is: where goods are made or services provided).

Where the commercial activities are located with a predominantly residential land use, Council will apply a Mixed Use rate which is lower than the commercial rate but higher than the residential rate.

The current rates are available in Councils Rating Strategy. For further information please contact Council's Financial Services on 03 5272 4650.

You are authorised to make this application as the proprietor or approved agent of the Food and/or Health business.

*You acknowledge and accept the Terms and Conditions of this application.

Privacy

This information is collected under the requirements of the Food/Public Health & Wellbeing Act for enforcement of Public Health purposes.

It may be provided to the Department of Health for the same purposes, and for the statistical purposes related to the application of the Act.

It will be treated in compliance with the Department of Health Information Privacy Principles and the Information Privacy Act.