974GOVERNMENT GAZETTE, WA 5 March 2021

974 GOVERNMENT GAZETTE, WA 5 March 2021 Additional details (a) Lodger’s meals will be provided by the manager/keeper/lodgers. (b) The keeper will/will not reside continuously on the premises. (c) Name and occupation of the proposed manager if the keeper resides elsewhere— .......................................................................................................................................................... (d) There will be ........... family members residing on the premises with the keeper/manager. Application fee of $ ............. is attached. ———— CERTIFICATE OF REGISTRATION OF A LODGING HOUSE (cl 8.1.4) 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 • recreational campsite, or • serviced apartments. until 30 June ....................., on the following conditions—

1. That........................................, whose name is entered on the register of keepers of the Shire of Broomehill-Tambellup, 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 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 on the premises shall not exceed............................................... This certificate of registration is issued subject to the Health Act and the Shire of Broomehill- Tambellup Health Local Law and is not transferable. Dated ................................................ Fee Received: $ ......................... Environmental Health Officer. ———— NOTICE OF CHANGE OF OWNER OF A LODGING HOUSE (cl 8.1.6) I/We, ............................................................................................................................................................... of ................................................................................................................................................................... am/are the new owners of premises situated at ....................................................................................................................................................................... which are registered in the name of ....................................................................................................................................................................... for the carrying on of the lodging house business.

5 March 2021 GOVERNMENT GAZETTE, WA 975 Schedule 4 REGISTER OF LODGERS (cl 8.3.2) Location of Lodging House ............................................................................................................................ ........................................................................................................................................................................ Date of Name Previous Signature Room Date of Arrival address Number Departure ............... ........................ ........................ ........................ .................. ........................ ............... ........................ ........................ ........................ .................. ........................ ............... ........................ ........................ ........................ .................. ........................ ............... ........................ ........................ ........................ .................. ........................ ............... ........................ ........................ ........................ .................. ........................ ———— Schedule 5 LIST OF LODGERS (cl 8.3.3) The following is the name of every person who resided in the lodging house at ....................................... ........................................................................................................................................................................ on the ........................... day of ........................................................ (Signed) ............................................ (Keeper) Date: ................................................. ———— Schedule 6 CERTIFICATE OF SLEEPING ACCOMMODATION FOR A LODGING HOUSE (cl 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. ————