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Application to Extend a Septic Tank PermitExtension to Permit to Install $200.00
1. An Extension application is required when a Wastewater Permit to Install has already been issued and is due to expire.
2. The Extension application will then need to be re-assessed, and if necessary a revised Permit to Install Issued before works can commence.
Current Permit to Install Details: Septic Tank Licence Number ST-______________________Property AddressStreet Address *
Suburb/Town *
State * Postcode *
Lot no: LP/CP CA/Section
Is the applicant: ☐ Owner ☐ Agent or Representative
Title * Surname * Given Names *
AddressStreet Address *
Suburb/Town *
State *
Postcode *
Mobile Phone
Email address *
* Required information
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.Name of person making this Date *
9 Smith Street (Private Bag 4) LeongathaTelephone: (03) 5662 9200 Facsimile: (03) 5662 3754
Email: [email protected] Website: www.southgippsland.vic.gov.au
Signature of person making this application *
application *
9 Smith Street (Private Bag 4) LeongathaTelephone: (03) 5662 9200 Facsimile: (03) 5662 3754
Email: [email protected] Website: www.southgippsland.vic.gov.au
Collection StatementYour 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. You may access your information by contacting Council via the contact details on this form or for further information on how your information is handled please refer to Council’s Privacy Policy at www.southgippsland.vic.gov.au/info/20004/your_council/170/privacy_statement
How to lodgeEmail: [email protected] Person: 9 Smith Street Leongatha Vic 3953By post: South Gippsland Shire Council
9 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 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.
Cheque: Payable to “South Gippsland Shire Council”, Private Bag 4, Leongatha, Vic 3953.
9 Smith Street (Private Bag 4) LeongathaTelephone: (03) 5662 9200 Facsimile: (03) 5662 3754
Email: [email protected] Website: www.southgippsland.vic.gov.au