08/2078 - MCU - Detached House [As Published] · 132008.2078

 

RECEIVED
7 JAN 2009

INTEGRATED PLANNING ACT 1997 Part N, Version 2.1, 3 March 2008

XS Form 1 Development Application

 

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

 

x Material change of use i) All or part of the premises is on the Environmental Management Register

DO (
C1 Reconfiguring a lot CO (i) Alor part of the premises is on the Contaminated Land Register
O i

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

OC (a) anotifiable activity

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

(1 (iv) Inan 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)

x (v) 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 (0 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 O, Confirmed

sensitive use (e.g. child care, educational, recreational or residential purpose, including yw Not applicable
@ 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 advite

* Part A must also be completed for all IDAS development applications.

* The applicant is responsible for answering al} questions fully and correctly, unless fotlowing a response there is a statement to go directly to
another question.

« For further information about completing this form go to -
* — IDAS Guide 5 (Contaminated land matters)
« —EPAcontaminated land website.

 

 

Page 4