National Environmental Management: Air Quality Act (39/2004): Atmospheric Emmission Licence Regulations 2010 (No. 141 of 2010)

www.saaqis.org.za 48 No. 32962 GOVERNMENT GAZETTE, 17 FEBRUARY 2010 SCHEDULE·C REPUBLIC OF SOUTH AFRICA CONSENT FORM TO UNDERTAKE ALISTED ACTIVITY ON LAND OWNED BY PERSON OTHER THAN THE APPLICANT, AS CONTEMPLATED IN REGULATION 12(2) OF THESE REGULATIONS This serves to confinn that I, name of owner of property) owner of---::-:- -:-----: -:--~ :----------,(insert ertor stand number ofthe property and physical address) hereby consent to ----,---,- (insert name of applicant in terms of these Regulations) undertaking the following activity (short description of the listed activity) in the abovementioned property. The consent is subject to the following conditions: (a) That the abovementioned applicant shall at all times comply with the relevant environmental legislation when undertaking the listed activity; (b) That any environmental liability during the operation of the listed activity lies with the applicant; and (c) That any environmental liability after the cessation of the fisted activity (for a period of 5 (five) years) shall be the responsibility of the applicant. Signed at this day of Signatures: Owner ofProperty Witness No.1 Applicant Witness No.2 Air Quality Officer Signature: Date: Printed by and obtainable from the Government Printer, Bosman Street, Private Bag X85. Pretoria, 0001 Publications: Tel: (012) 334-4508, 334-4509, 334-4510 Advertisements: Tel: (012) 334-4673. 334-4674, 334-4504 Subscriptions: Tel: (012) 334-4735, 334-4736, 334-4737 Cape Town Branch: Tel: (021) 465-7531 32962-1