Change Application - Completed · MCU18/0013.01

Department of Infrastructure, Local Government and Planning

 

Privacy — Personal information collected i in this form will be used by the responsible entity and/or. chosen assessment
manager, any relevant af y or referral agency and/or: buildin y pro sional advisers which
maybe engaged by those entities) while processing, assessing and deciding the change app cation.
All information relating to this chanc application may be available for inspection and purchase, and/or published on the
assessment manager's and/or ret ie website.
Personal information wil not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Regulation 2017 and
the DA Rules. except where:
° such disclosure is in r
2016 and. the Planning Re
Regulation: 2017; or
e -required by other legi
° otherwise required by law.
This information may be stored in relevant databases. The information collected will be retained as required by the Public
Records Act 2002.

PART 7 — FOR OFFICE USE ONLY

Date received: fd] Reference number(s): |

ORES Oe and aul

    
 

  
 

 

 

     
 

cess to. documents contained in the Planning Act

with the provisioris about public
de under the Planning Act 2016 and Planning

ation 2017, and. the access rules

  

ion (including the Right: to Information Act 2009); or

 

  

 

 

 

 

 

 

QLeave project number
Amount paid ($) /
Date ald /

 

 

 

 

 

 

 

 

 

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and ail other required change application materials should be

sent to the responsible entity.

Page 4
Planning Act Form 5 - Change application form
Version 1.0—3 July 2017