City of south perth




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Schedule 2
City of South Perth
HEALTH ACT 1911
CERTIFICATE OF REGISTRATION OF A LODGING HOUSE
THIS is to certify that the premises situated at___________________________________________________
are registered as a Lodging House and classified as:

a lodging house


a short term hostel




serviced apartments


a recreational campsite
until 30 June 20_____, on the following conditions:
1. that________________________________, whose name is entered on the register of keepers of the City of South Perth, continues to be the keeper of the lodging house;
2. that___________________________, appointed by the keeper to be the manager of the lodging house, continues to be the manager of the lodging house;
3. that the Certificate of Registration is not sooner cancelled or revoked;
4. that the maximum number of rooms to be used as sleeping apartments for lodgers is -________________; and
5. that the maximum number of lodgers accommodated on the premises shall not exceed ____________
This Certificate of Registration is issued subject to the Health Act and Health Local Laws of the City of South Perth and is not transferable.

Dated __________________


_________________________________________

Manager, Environmental Health & Regulatory Services

City of Perth
Fee received: $_____________________


Schedule 3
City of South Perth
HEALTH ACT 1911
NOTICE OF CHANGE OF OWNER OF A LODGING HOUSE

To: Chief Executive

City of South Perth
I/We, __________________________________________________________________________________

(Full Name of Applicant/s)

of ______________________________________________________________________________________

(Residential Address of Applicant/s)

am/are the new owner/s of premises situated at __________________________________________________
________________________________________________________________________________________
which are registered in the name of ___________________________________________________________
for the carrying on of the lodging house business.


__________________________________________

(Signature of Applicant/s)

__________________________

(Date)


Schedule 4
City of South Perth
HEALTH ACT 1911
REGISTER OF LODGERS
Location of Lodging House: _______________________________________________________________
_______________________________________________________________________________________


Date of

Arrival


Name

Previous Address

Signature

Room

Number


Date of Departure








































































































































































































Schedule 5
City of South Perth
HEALTH ACT 1911
LIST OF LODGERS
The Chief Executive

City of South Perth


The following is the name of every person who resided in the lodging house at ________________________


________________________________________________________________________________________

on the _________________________ day of _________________________ 20____.

_________________________________________ ______________________

(Signed - Keeper) (Dated)



Schedule 6
City of South Perth
HEALTH ACT 1911
CERTIFICATE OF SLEEPING ACCOMMODATION FOR A LODGING HOUSE

To:________________________________________________________________________________

(Name of Keeper)

of _________________________________________________________________________________

(Address of Keeper)

For the registered lodging house situated at: ________________________________________________


____________________________________________________________________________________
The rooms listed in the following table are not to exceed the number of lodgers or residents indicated below;


Room Number

Maximum Occupancy



















Date ________________________________


__________________________________________

Manager, Environmental Health & Regulatory Services



Schedule 7
City of South Perth
HEALTH ACT 1911
APPLICATION FOR LICENCE OF A MORGUE

To: Chief Executive

City of South Perth

I ____________________________________________________________________________________

(full name in block letters)
of ___________________________________________________________________________________

(full residential address)


apply to licence the premises listed below as a Morgue
Address of premises:_____________________________________________________________________
______________________________________________________________________________________
Name of premises: _______________________________________________________________________
Dated this ____________________ day of __________________ 20____
____________________________________________________

(Signature of Applicant)




Schedule 8
City of South Perth
HEALTH ACT 1911
CERTIFICATE OF LICENCE OF A MORGUE
This is to certify the following premises is licensed as a Morgue from the _________________ day of _____________________ 20____ until the 30th day of June 20______.
Address of premises: ___________________________________________________________________
Name of premises;______________________________________________________________________
Dated this _____________________ day of _________________ 20____.

________________________________________

Manager, Environmental Health & Regulatory Services

City of South Perth



Schedule 9
City of South Perth
HEALTH ACT 1911
APPLICATION FOR CONSENT TO ESTABLISH AN OFFENSIVE TRADE
To: Chief Executive

City of South Perth


I/We, ________________________________________________________________________________

(Full Name of Applicant/s)


of ___________________________________________________________________________________

(Residential Address of Applicant/s)


apply for consent to establish an offensive trade being _________________________________________
_____________________________________________________________________________________

(Description of Offensive Trade)


in or upon _____________________________________________________________________________

(Location of the House or Premises)


Notice of my/our intention to make this application was advertised in _______________________________

(Name of Newspaper)

on ______________________________________.

(Date of Advertisement

Plans and specifications of the buildings proposed to be used or erected in connection with the proposed offensive trade are attached.

_____________________________________ ____________________

(Signature of Applicants/s) (Date)

Schedule 10
City of South Perth
HEALTH ACT 1911
APPLICATION FOR REGISTRATION OF PREMISES FOR OFFENSIVE TRADE
To: Chief Executive

City of South Perth


I/We, ________________________________________________________________________________

(Full Name of Applicant/s)


of ___________________________________________________________________________________

(Residential Address of Applicant/s)


apply for registration, for the year ended __________ of ________________________________________

(Location of Premises)

being premises in or upon which there is (or is to be) carried on an offensive trade, namely; ___________
______________________________________________________________________________________
under the business name of _______________________________________________________________
The prescribed registration fee of $____________ is attached.

________________________________ ____________________________

(Signature of Applicant/s) (Date)

Schedule 11
City of South Perth
HEALTH ACT 1911
CERTIFICATE OF REGISTRATION OF PREMISES FOR OFFENSIVE TRADE
This is to certify that the premises situated at __________________________________________________
_______________________________________________________________________________________
of which ___________________________________________________________________is the occupier,
are registered for the carrying on of the trade of ________________________________________________
Trade Name_____________________________________________________________________________
This registration expires on the _________________ day of ____________________20___.

__________________________________ _____________________

Manager, Environmental Health & Regulatory Services (Date)

City of South Perth

Passed at a meeting of the local government of the City of South Perth held on _____________________.

(Date)
The Common Seal of the City of South Perth was hereunto affixed in the presence of:-


_________________________ ______________________

Mr Julian Donaldson (Date)

CHAIRMAN OF COMMISSIONERS
__________________________ ______________________

Mr Cliff Frewing (Date)



ACTING CHIEF EXECUTIVE
________________________________ _______________________

CONFIRMED - Executive Director Public Health (Date)
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