Document ID: chunk:federal_register_of_legislation:F2018N00131:schedule:3:p1
Version: federal_register_of_legislation:F2018N00131
Segment Type: schedule
Provision Reference: sch 3 (pt 1/2)
Character Range: 123569–134232

Schedule 3

                       Shire of Christmas Island

                       PUBLIC HEALTH ACT (WA) (CI) 2016

            NOTICE OF CHANGE OF OWNER OF A LODGING HOUSE
[Clause 8.1.6]

  To: Chief Executive Officer, Shire of Christmas Island

  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

                       Shire of Christmas Island

                       PUBLIC HEALTH ACT (WA) (CI) 2016

                     REGISTER OF LODGERS
[Clause 8.3.2]

  Location of Lodging House

  .........................................................................................................................................................

  ........................................................................................................................................................

   Date of Date of
   Arrival Name Previous Address Signature Room No. Departure

  .........................................................................................................................................................

  .........................................................................................................................................................

  .........................................................................................................................................................

  .........................................................................................................................................................

  .........................................................................................................................................................

  .........................................................................................................................................................

       ……………………………………………………………………………………………………………………

_________________________

                        Schedule 5

                      Shire of Christmas Island

                      PUBLIC HEALTH ACT (WA) (CI) 2016

LIST OF LODGERS
[Clause 8.3.3]

 TO: The Chief Executive Officer, Shire of Christmas Island

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

 .........................................................................................................................................................

 .........................................................................................................................................................

 on the ...................................................  day of .........................................................................

 (Signed) ................................................
           (Keeper)

 Date: .....................................................

_________________________

                        Schedule 6

                      Shire of Christmas Island

                      PUBLIC HEALTH ACT (WA) (CI) 2016

     CERTIFICATE OF SLEEPING ACCOMMODATION FOR A LODGING HOUSE
[Clause 8.3.4]

 To: ............................................................................................................................................................
                       (Name of Keeper)
 of ............................................................................................................................................................
                      (Address of Keeper)

 For the registered lodging house situated at
 ............................................................................................................................................................

 ..........................................................................................................................................................

 The rooms listed below are not to be occupied by more than the number of lodgers or residents indicated below.

  ROOM NUMBER: MAXIMUM OCCUPANCY

 ............................................................................................................................................................

 ............................................................................................................................................................

 ............................................................................................................................................................

 ............................................................................................................................................................

 ............................................................................................................................................................

 ............................................................................................................................................................

 Date: ............................................
                                      .............................................................
                                      Environmental Health Officer
                                      Shire of Christmas Island

                        __________________

                        Schedule 7

                      Shire of Christmas Island

                      PUBLIC HEALTH ACT (WA) (CI) 2016

                          APPLICATION FOR LICENCE OF A MORGUE
[Clause 3.5.1 (2)(b)]

 To: Chief Executive Officer, Shire of Christmas Island

 I ............................................................................................................................................................
                    (Full name in block letters)
 of ............................................................................................................................................................

(Residential Address).
 apply to licence the premises listed below as a Morgue.
 Address of premises:
 ............................................................................................................................................................

 ............................................................................................................................................................

 Name of premises:

 .............................................................................................................................................................

 .............................................................................................................................................................

  Dated this .................................................... day of ........................................................

                                  ...............................................................
                                    (Signature of Applicant)

_________________

                         Schedule 8

                       Shire of Christmas Island

                       PUBLIC HEALTH ACT (WA) (CI) 2016

                              CERTIFICATE OF LICENCE OF A MORGUE
                      [Clause 3.5.1 (4)(a)]

  This is to certify the following premises is licensed as a Morgue from the

  ..............................  day of....................................... until 30th Day of June......................................

  Address of premises:
  ..........................................................................................................................................................

  ..........................................................................................................................................................

  Name of Premises:
  ..........................................................................................................................................................

  ..........................................................................................................................................................

  Dated this ............................................. day of ..............................................................................

                                      ...............................................................
                                      Environmental Health Officer
                                      Shire of Christmas Island

__________________

                         Schedule 9

                       Shire of Christmas Island

                       PUBLIC HEALTH ACT (WA) (CI) 2016

      APPLICATION FOR CONSENT TO ESTABLISH AN OFFENSIVE TRADE
[Clause 9.1.2]

 To: Chief Executive Officer, Shire of Christmas Island

 I/We,....................................................................................................................................................
 (Full Name of Applicant/s)

 of.........................................................................................................................................................
 (Residential Address of Applicant/s)

 apply for consent to establish an offensive trade being

 ............................................................................................................................................................
 (Description