Title Page
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Site conducted
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Conducted on
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Prepared by
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CS / ECM Number
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Applicants Name
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Applicants street / Road address
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Area
- Appin South
- Bael Bael
- Beauchamp
- Benjeroop
- Budgerum East
- Cannie
- Cohuna
- Cullen
- Daltons Bridge
- Dingwall
- Horfield
- Gannawarra
- Gonn Crossing
- Horfield
- Kangaroo Lake
- Kerang
- Kerang Airport
- Kerang East
- Koondrook
- Lalbert
- Lake Charm
- Lake Meran
- Leitchville
- Macorna North
- Mead
- Meatian
- Meering West
- Mincha West
- Mc Millans
- Murrabit
- Murrabit West
- Myall
- Mystic Park
- Ninyeunook
- Normanville
- Quambatook
- Sandhill Lake
- Teal Point
- The Bannacher
- Tragowel
- Wandella
- Wee Wee Rup
- Westby
- Other
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Other Area if not listed
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Any prior complaints
- No prior complaints
- Inadequate containment
- Noise / barking Issues
- Odour Issues
- Dust Issues
- Vermin or reptile harbourage
- Insect / mite
- Aggression against people
- Aggression against animals
- Has previously attacked
- Other, reference in notes
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Type of Animal
- Cats
- Dogs
- Poultry - no roosters
- Domestic Birds (caged) - Canaries / finches / budgies
- Large birds - Peacock / Guinea Fowl / Pheasant / Turkey types.
- Rooster/s - High Noise Bird
- Pigeons
- Cattle - cows / heifers / steers
- Bull
- Horses / Donkeys - female / gelded
- Stallion
- Sheep / Goats
- Pigs
- Other - Describe in notes
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Other Animal Type
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Are they an Exotic / Native Species needing additional permits / approvals
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Is this for a Declared Dangerous or Menacing Dog
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Property type / size
- 0.5 Hectare or less in built up area
- 0.5 - 2.0 Hectare in built up area
- Farm Zone
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Enclosure / Fence Type
- Dog Enclosure / Kennels
- Enclosure is compliant for a Declared Dog
- Cattery / outdoor enclosures or run
- Purpose built aviary
- Coop / Run
- Tin Fence
- Wooden paling fence
- Rural wire fencing
- Residential wire fencing
- Residential Wooden Fence
- Electric Fence - Farm Zone only
- Other
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Is containment adequate for the type of animal/s to be kept
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Number of additional Animals
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Is adequate shelter available for hot and cold conditions
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Food storage
- Sealed vermin proof containers
- Fodder (Hay / Chaff etc) suitably stored.
- Satisfactory for purpose
- Food storage vermin attractant
- Fodder storage provides vermin /reptile harborage
- Not currently fit for purpose
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Yard / Enclosure Photos
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Outcome of inspection
- Approved for permit issue
- Failed - Works required
- Fail - Property unsuitable for intended purpose permit is refused.
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Date Time Completed
