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9 Smith Street (Private Bag 4) LeongathaTelephone: (03) 5662 9200 Facsimile: (03) 5662 3754
Email: [email protected] Website: www.southgippsland.vic.gov.au
Application to Amend a Septic Tank PermitMinor Amendment $115.00 Changes to one component of the system or reassessment of the same system designed by
a different installer
Major Amendment $373.00Changes to two or more components of the system
Is the applicant? ☐ Owner ☐ Agent of Owner
Title* Surname* Given Names*
Property Address
Street Address*
Suburb/Town* State* Postcode*
Mobile Phone
Email address*
* Indicates a mandatory field
Checklist of information to provide in support of your application
Septic site plan to scale – (no less than 1:100) Showing proposed dwelling and ancillary buildings/structures, location of the proposed Septic tank system
Floor Plan of the proposed dwelling to scaleClearly show dimensions and existing/proposed rooms and structures
9 Smith Street (Private Bag 4) LeongathaTelephone: (03) 5662 9200 Facsimile: (03) 5662 3754
Email: [email protected] Website: www.southgippsland.vic.gov.au
Description of Amendment Requested
Declaration*
The information provided in this application is true and complete to the best of my knowledge.This application forms a legal document and penalties exist for providing false or misleading information.
Signature of person making this application*
Name of person making this application* Date*
9 Smith Street (Private Bag 4) LeongathaTelephone: (03) 5662 9200 Facsimile: (03) 5662 3754
Email: [email protected] Website: www.southgippsland.vic.gov.au
Important Notes1. An Amendment application is required when a Septic Tank Permit to Install has already been issued.
2. The Amendment will be assessed, and an Amended Permit to Install must be Issued before works can commence.
Collection Statement
Your personal information is being collected by South Gippsland Shire Council for the purpose of processing your application in accordance with the Environmental Protection Act 1970. Your information will be stored in Council’s Customer Database and used to identify you when communicating with Council and for the delivery of services and information. For further information on how your personal information is handled, refer to Council’s Privacy Policy at www.southgippsland.vic.gov.au/info/20004/your_council/170/privacy_statement
How to lodge
Email: [email protected]
In Person: 9 Smith Street Leongatha Vic 3953
By post: South Gippsland Shire Council9 Smith Street, Private Bag 4Leongatha VIC 3953
How to pay
Payment Options
Online Payment www.southgippsland.vic.gov.au Payment Reference: Invoice will be raised once application has been received a payment reference will be emailed to applicant to use on the Council online payment portal.
Credit Card:Call Customer Service on (03) 5662 9200 and have your Payment Reference available to quote to the Customer Service staff member (see top right corner).
Cheque: Payable to “South Gippsland Shire Council”, Private Bag 4, Leongatha, Vic 3953.
