01 RAL21-0026 Minor Change Application Form 5

PART 8 - FOR COMPLETION OF THE ASSESSMENT MANAGER — FOR OFFICE
USE ONLY

 

Date received: eee Reference number(s): [ |

QLeave notification and payment

    

Note: For completion by as sment manager if applicable
Description of the work
QLeave project number
Amount paid ($) [ Date paid (dd/mmiyy) |
Date receipted form sighted by assessment manager
Name of officer who sighted the form

 

 

 

 

 

 

 

 

 

Page 5
Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020