Street Stall / Fundraising application form

STREET STALL / FUNDRAISING APPLICATION FORM

For further information or questions regarding this form, please contact Council via 9911 6555.

Name of organisation *

Surname *

First Name *

Email *

Contact Number *

Address *

Suburb *

Postcode *

Type of activity: *

StallFundraising

Purpose of activity: *

Details of type and material of proposed outdoor furniture: *

Site location: *

Date of activity: *

End time: *

Start time: *

Fund registration number:

Authority to Fundraise for charitable purposes: *

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Issued by the NSW Government under the Charitable Fundraising Act 1991

Current Public Liability Insurance policy: *

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For $20 Million with City of Canada Bay Council as an interested party

A site plan of the proposed use of the footpath area drawn to scale must indicate:

Location of site
Dimensions and boundaries of the proposed display area
Area (in square metres) of the outdoor occupation
Number and location of proposed tables/chairs
Kerb line of the street where the area is located
Width of the footpath adjacent to the subject premises and its remaining width after the encroachment by the proposed outdoor occupation
Location and details of any parking restrictions applying at the kerb
Proximity of pedestrian or vehicular entrances serving the adjoining buildings
Location of all existing free-standing items on the street such as bus stops, post office boxes, power poles, street furniture, rubbish bins, parking / street signs or other similar items, that are adjacent to the site

Site plan: *

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Drawn to scale (1:100 or 1:200)

I hereby certify that I have received and understood the conditions under which approval is to be given and agreeto adhere to those conditions.

Applicant Signature *

Draw signature|Type signatureClear

Date signed *