PlanningActForm5-Changeapplicationform (2) · 132007.12.8

 ☒ No – proceed to 9)
   Yes – the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 as these sections relate to the
 new or changed aspects of development are provided with this application.
 8.2) Does the change application involve building work?
     No
 ☒ Yes – the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided with
 this application.

 9) Referral details - Do any aspects of the change application require referral for any referral requirements?
 Note: The application must be referred to each referral agency triggered by the change application as if the change application was the original
 development application including the proposed change.

 ☒ No
    Yes – the completed Sections 1 and 2 of Part 5 (Referral details) of DA Form 1 as it relates to the change application is
 provided with this application. Where referral is required for matters relating to building work the referral checklist for
 building work is also completed.

 10) Information request under Part 3 of the DA Rules

 ☒ I agree to receive an information request if determined necessary for this change application
     I do not agree to accept an information request for this change application
 Note: By not agreeing to accept an information request I, the applicant, acknowledge:
 • that this change application will be assessed and decided based on the information provided when making this change application
     and the assessment manager and any referral agencies relevant to the change application are not obligated under the DA Rules to
     accept any additional information provided by the applicant for the change application unless agreed to by the relevant parties
 • Part 3 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules.
 Further advice about information requests is contained in the DA Forms Guide.


 11) Further details

 ☒ Part 7 of DA Form 1 is completed as if the change application was a development application and is provided with this
 application.

PART 6 – CHECKLIST AND APPLICANT DECLARATION
 12) change application checklist
 I have identified the:
      • responsible entity in 3); and
      • for a minor change, any affected entities; and                                                            ☒ Yes
      • for an ‘other’ change all relevant referral requirement(s) in 9)
 Note: See the Planning Regulation 2017 for referral requirements
 For an ‘other’ change application, the relevant sections of DA Form 1 – Development
 details have been completed and is attached to this application
                                                                                                                  ☒ Yes
                                                                                                                      Not applicable
 For an ‘other’ change application, where building work is associated with the change
 application, the relevant sections of Form 2 – Building work details have been                                   ☒ Yes
 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                    ☒ Yes
 relevant categorising instrument(s) (e.g. the local government planning scheme, State Planning
 Policy, State Development Assessment Provisions). For further information, see DA Forms
 Guide: Planning report template.
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                                                                                                         Planning Act Form 5 - Change application form
                                                                                                                              Version 1.0—3 July 2017