= Required Fields

Online Form - Application for Variation of Certificate of Approval

A confirmation message will appear once the form is submitted please retain this as evidence of submission.

If you have any questions or concerns with the application process please contact Shire of Exmouth Environmental Health Services on 9949 3000.

Please tick the box below applicable to your application


Have you received planning advice and approval?

Site Map/Building Plans 

Please upload as much detail as possible including but not limited to exit widths, toilets, ventilation, structures, licensed area and available floor space (no hand drawn plans will be accepted)

Premise Details

Contact Details

Declaration 

Declaration

 
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