IDAS Forms REC17/0013

                                                                          Department of Infrastruclure,     local Government and Planning



•    is in relation to the acquisition, including by agreement, under the Acquisition of Land Act                  DYes         BNo
      1967 or otherwise, of land by:
     i)      a constructing authority, as defined under that Act, for a purpose set out in parts 1 to 13
             (other than part 10, second dot point) of the schedule to that Act, or
     ii)     an authorised electricity entity, or

•    is for land held by the state, or a statutory body representing the state, and the land is being              DYes         [3'No
     subdivided for a purpose set out in the Acquisition of Land Act 1967, schedule, parts 1 to 13
     (other than part 10, second dot point) whether or not the land relates to an acquisition, or

•    is for reconfiguring a lot comprising strategic port land, or                                                 D    Yes     S No
•    is for reconfiguring a South Bank lot within the corporation area under the South Bank                        D    Yes     [;2JNo
     Corporation Act 1989, or

•    is for the Transport Infrastructure Act 1994, section 240, or                                                 D    Yes     ~No

•    is in relation to the acquisition of land for a water infrastructure facility, or                             D    Yes     [;if No
•    is for land in a priority development area.                                                                   D    Yes     [;2( No
•         If yes to any of the above, and this is the only aspect of your development, then you do not require a
          development permit. End of checklist.
•         If no to all of the above, then your development requires a development permit, and you must submit a
          development application to your local government as assessment manager. Please contact your local
          government for further information. End of checklist.

Privacy-Please   refer to your assessment           manager    or referral agency for further     details on the use of
information recorded in this form.


Disclaimer:
While DILGP believes that the Information contained on this form and provided as part of this process will be of
assistance to you, it is provided on the basis that you will not rely on the information. It is your responsibility to make
your own enquiries regarding the interpretation and application of the applicable legislation to your circumstances.


To the full extent permitted by law, DILGP expressly disclaims all liability (including but not limited to liability for
negligence) for errors or omissions of any kind or for any loss (including direct and indirect losses), damage or other
consequence which may arise from your reliance on this process and the information contained on this form.




OFFICE USE ONLY

Date received      _1                                   1   Reference numbers



The Sustainable Planning Act 2009 is administered by DILGP. This checklist and all other required application
materials should be sent to your assessment manager and any referral agency.




                                                                                                          Checklist 3-Reconfiguring a lot
                                                                                                             Version 3.2-3 Augus' 2015