Sections 168(1), (2) and 181 and clause 4 of First Schedule, Resource Management Act 1991
To [name of territorial authority]
[Full name] gives notice of a requirement for a designation (or for an alteration to a designation) for a public work (or for a project or work or in respect of any land, water, subsoil, or airspace where a restriction is necessary for the safe or efficient functioning or opera-tion of a public work or project or work).
The site to which the requirement applies is as follows:
[describe the site as it is commonly known and in a way that will enable it to be easily identified (eg, the street address, the legal description, proximity to any well-known landmark, the grid refer-ence (if known))].
The nature of the proposed public work (or project or work) is:
[give details].
* The nature of the proposed restrictions that would apply are:
[give details].
* Delete if there are no proposed conditions.
The effects that the public work (or project or work) will have on the environment, and the ways in which any adverse effects will be mitigated, are:
[give details].
Alternative sites, routes, and methods have been considered to the following extent:
[give details].
The public work (or project or work) and designation (or alteration) are reasonably necessary for achieving the objectives of the requiring authority because:
[give details].
* The following resource consents are needed for the proposed activ-ity and have (or have not) been applied for:
[give details].
* Delete if resource consents are not needed for the proposed activity.
Form 18 - continued
The following consultation (or No consultation) has been undertaken with parties that are likely to be affected:
[give details].
[Full name of person giving notice] attaches the following informa-tion required to be included in this notice by the district plan, regional plan, or any regulations made under the Resource Management Act 1991.
[List documents that you are attaching.]
..................................................
Signature of person giving notice
(or person authorised to sign
on behalf of person giving notice)
..................................................
Date
Note to person giving notice
You must pay any charge payable to the territorial authority for the requirement or alteration to the requirement under the Resource Management Act 1991.