Minor Change Application - 14-16 Reserve St, Pomona - MCU22-0097.02

     PART 8 – FOR COMPLETION OF THE ASSESSMENT MANAGER – FOR OFFICE
     USE ONLY

        Date received:                                   Reference number(s):

        QLeave notification and payment
        Note: For completion by assessment manager if applicable
        Description of the work
        QLeave project number
        Amount paid ($)                                                 Date paid (dd/mm/yy)
        Date receipted form sighted by assessment manager
        Name of officer who sighted the form




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                                                                                           Planning Act Form 5 - Change application form
                                                                                                          Version 1.2 — 7 February 2020
Document Set ID: 24937252
Version: 1, Version Date: 09/07/2026