Ethekwini Municipality Vacancy Form – Fill Out and Use This PDF

APPLICATION IN TERMS OF SEC. 4(2) OF ACT NO. 103 OF 1977

Please Tick ( ) the Appropriate boxes & Complete all documentation in BLACK INK only

	Proposal:	New	Additional /					M.B.W	Deviation to
			Alterations					( Minor Building Work )	Approved plan number :
	Residential:	Dwelling					Townhouse		Flat	Tourism / Accommodation / Casino
		No. of Units (specify)
		(where Townhouse or Flats selected above) :								Units
		Other Residential		(specify)
	Non-	Office / Banking				Industrial / Warehousing /			Shopping Space		Worship / Sports /
	Residential:							Workshop			Recreational Clubs
				Hospital / Clinics					School / Creche / University / Technikon / Library
		Other Non-Residential (specify)
	Within:	Ethekwini			Former Township / R293 Areas				Council Strategic Project		Government / Courtesy
											application
	Proposed:	Value:							Projected cost of proposed building work – required for
		R :							statistical purposes for Statistics SA, not for valuation purposes
	Proposal	Encroachment/s into/over/under Council property or servitude							Yes		No
	contains:	area in favour of the Local Authority
	Description
	of Works
	Proposed

		NOTE: The Owner & Author are responsible for tracking the status of the application once submitted to the Council.
	Applicant /		[ One of the following methods of communication will be used to communicate the Council’s decision. ]
	Corresponden	Applicant / Correspondent’s Name:
	t
		Postal Address:
	Contact
	Person for			Code:
	Decision
	Notices
		Email:		Fax:
	The reasons for a
		NOTE: Any decision notice will be directed to both the Owner and Correspondent with confirmation of receipt being on proof of sending. Reasons for the
	refusal will not be
	read out over the	refusal, where applicable, will be provided at the time of collection.
	phone.

Property Owner’s Details: [ Non-compliance with the Submission Checklist will result in the Application being refused creating un-necessary delays for the Owner / Applicant. ]

Owners Name: ___________________________________________________________________________________________ Mr/Mrs/Miss

Owners Name: ___________________________________________________________________________________________ Mr/Mrs/Miss

Domicilium Citandi et Executandi _________________________________________________________________________________________

(Physical Address)

___________________________________________________________________________________________ Code: ___________________

Postal Address: _______________________________________________________________________________________________________

___________________________________________________________________________________________ Code: ___________________

(W)__________________________________ (Fax) _________________________________ (Cell) ___________________________________

(H)__________________________________ (email) ________________________________________________________________________

DECLARATION BY OWNER

I/We declare that I/we have personally checked the Title Deeds or any other document for the property concerned and that the proposed work is not contrary to any restrictive conditions or servitudes applicable thereto. I/We further declare that the boundary beacon pegs conform with positions as per the applicable Approved SG Diagram. I/We declare to that the application does not conflict with any other applicable laws, eg.: KWAZULU- NATAL HERITAGE ACT, 1997, etc., and that ALL information as provided is true and correct. In the event of any contraventions, I/we will bear the sole responsibility to rectify the aforesaid contraventions.

Owner’s Signature: ______________________________________________________________________	Date: ______________________
Owner’s Signature: ______________________________________________________________________	Date: ______________________

POWER OF ATTORNEY

I/We _________________________________________________________________________________________________ ( Owner/s Name )

being the registered owner/s of the property on which the proposed work is to be undertaken, hereby nominate, constitute and appoint,

__________________________________________________ ( Name of Appointee ) ID No.: _________________________________________

and / or

__________________________________________________ ( Name of Appointee ) ID No.: _________________________________________

with power of substitution to be my/our true and lawful attorney and agent with respect to this application, to sign all Local Authority documents / plans and provide such information as is required of an owner by the National Building Regulations and to do whatsoever shall be necessary as effectively as I could do if personally present and hereby promising to ratify and confirm all that my agent shall lawfully do by virtue hereof.

Owner’s Signature: ______________________________________________________________________

Date: ______________________

NOTE: This P.O.A does not authorise an Architectural professional to sign the SACAP Architectural Compliance Certificate on behalf of the Owner / Authorised Agent.

AWNING / TIMBER DECK INDEMNITY ( to be completed where applicable )

I/We _________________________________________________________________________________________________ ( Owner/s Name )

being the registered owner/s of the property on which the proposed work is to be undertaken, hereby indemnify the eThekwini Municipality ( herein after referred to as “the Council” ) and hold it harmless against:

1.Liability in respect of any claims which may be made against the Council arising out of damage to the property, whether movable or immovable, of any third parties, including any consequential damage, directly or indirectly flowing form any physical damage to such property,

2.Liability in respect of the death or injury to any person, and any consequential damage or loss directly or indirectly flowing therefrom,

3.Any claims in respect of any loss or damage suffered by any person and any consequential loss or damage directly or indirectly flowing therefrom,

4.Any legal costs or expenses reasonably incurred in connection with claims or actions arising out of the forgoing;

Wherever the damage, loss injury or death contemplated in 1, 2 & 3 above is due to or arising out of, whether directly or indirectly, the erection of the awning/s and/or timber deck/s by or on behalf of the registered owner.

Owner’s Signature: ______________________________________________________________________	Date: ______________________
(Registered owner of property)
Note:

ADDITIONAL	Sewer connection to the Local Authority sewer:				Yes		No
REQUIREMENTS	Size Required:				100Ø	or	150 Ø
	Connection is:				1st	or	2nd	connection to sewer and
	Connected by:				L/A Plumber	or	Private Reg. Plumber
FOR OFFICE USE ONLY			RECEIVED BY :					(Print Name & Sign)
	AMOUNT		DEBIT NUMBER		DATE	RECEIPT NUMBER			DATE
Building Plan Fee	R
Sewer Conn. Fee	R
Water Conn. Fee	R
Additional Fee	R
Other fee	R
REFUND DUE	R					Signature :