The road manager or trustee of the reserve proposed to be impacted by an application must complete this statement.
This statement should not be completed by the applicant.
Statement in relation to an application under the Land Act 1994 over state land
This statement is used by a road manager or trustee of a reserve to support the following applications proposed to impact road or reserve land:
- Permit to occupy (local road or reserve)
- Purchase state land (reserve)
- Lease state land (reserve)
- Road closure
- Road licence
- Simultaneous road closure and opening.
Next step
To access the application form
- Please read the information below.
- Use the button at the base of the page to acknowledge you have understood and this will allow you to access the application form.
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- You will need to review the application and all supporting documentation attached to the email provided
- Complete the statement, including the application and all supporting documents
- Ensure you enter the applicant’s email address on the statement.
- Once you have completed the statement, both you and the applicant will receive a confirmation email from the department
Once the road manager or trustee has submitted the statement, the department will start to verify and assess the application.
Information on this form, and any attachments, is being collected to process and assess an application under the Land Act 1994. The consideration of the statement may involve consultation, and if so, details of the statement may be disclosed to third parties. They will not be otherwise disclosed outside the department unless required or authorised by law.
I have read and understood this information Agree