08/0310 - MCU - Wellbeing Type 2 - Social [As Published] · 132008.310

INTEGRATED PLANNING ACT 1997 , Part N, Version 2.0, 3 September 2007

Form’ Development Application (tes
Part N

Contaminated land

    

Nature of the application and contamination

1. What is the nature of the application and the nature of the contamination on the premises? {Tick applicable box/es)

 

Nature of the application Nature of the contamination

 

(7 Material change of use | (] (i) Alor part of the premises is on the Environmental Management Register
(J Reconfiguring a tot (1 (i) Alor part of the premises is on the Contaminated Land Register

(2) (ii) All or part of the premises is currently used for, or if there is no existing use, was last
used for -

©) (a) anotifiable activity

(0 (b) anindustrial activity and the proposed use is for a child care centre,
educational, recreational or residential purpose (including a caretaker
Tesidence on industrial land)

(1 (iv) Invan area for which an ‘area management advice’ has been given for natural
mineralisation or industrial activity and the proposed use is for a child care centre,
educational, recreational or residential purpose (including a caretaker residence on
industrial land)

ww) In an area for which an ‘area management advice’ has been given for unexploded

 

 

 

ordnance

 

Mandatory information

2. Confirm the following mandatory information accompanies this application.

 

 

 

 

 

 

 

 

 

 

Confirmation of Method of lodgement
: lodgement
(i) Plans showing where any notifiable activities, hazardous contaminant or potentially (1 Confirmed
contaminated activity has occurred on the premises
(ii) If the application involves a material change of use from an industrial use to a more 0 Confirmed
sensitive use (e.g. child care, educational, recreational or residential purpose, including |] Not applicable
a caretaker residence on industrial land), a detailed site history outlining previous
potentially contaminated uses on the premises
OFFICE USE ONLY
[Date received | | _ [Reference numbers . |

 

Advice for completing Part N

 

 

General advice _
« Part A must also be completed for all IDAS development applications.
+ All questions must be answered unless, following a response, there is a statement to go directly to 2 particular question.
» For further information about completing this form go to -
» — IDAS Guide 5 (Contaminated land matters)

 

« — EPA contaminated land website.

 

xO