Change Application - Completed · MCU18/0013.01

Department of infrastructure, Local Government and Planning

ates fo the change application is
ork the referral checklist for

 

 

 

 

 

 

 
    
  
 
    

OYes

 

O1 Yes
erNtot applicable

For an ‘other change application, where buildi rk 1S: ass i ang C1 Yes

application, the relevan
completed and is attached to this application [Not applicable

Supporting information addressing any applicable assessment benchmarks is attached

to this application

Note: This includes any templates provided under 23.6) of DA Form 1 that are relevant as a

result of the change application, a planning report and any technical reports required by the C1 Yes
relevant categorising instrum int(s) (e.g. thé local government planning scheme, State Planning

Policy, State Development A. ment Provisions). For further information, see DA Forms

 

 

 

Relevant plans of the development are attached to this development application im
Yes

Note: Relevant plans are required to be submitted for all relevant aspects of this: change
application. For further information, see DA Forms Guide: Relevant plans.

 

Where an 1 email address is provided in Part 4 of this form, | consent to. receive future electronic communications from
the responsible entity and any relevant affected entity or referral agency for the change application where written
information is required or permitted pursuant to sections 11 ard 12 of the Electronic Transactions Act 2001.
Note: It is unlawful to intentionally provide false or misleading information.

 

 

 

Page 3
Planning Act Form 5 - Change application form
Version 1.0—3 July 2017