MCU12/0023 Development Application part 1 IDAS Form 1 & 5 Checklist 1 & 2

3. Confirm that the following mandatory supporting information accompanies this application

Plans                                                                         Confirmation of
                                                                                              Method of lodgement
                                                                              lodgement
plans showing where any notifiable activities, hazardous contaminant or
                                                                              Liconfirmed
potentially contaminated activity has occurred on the premises
Written documentation

if the application involves a material change of use from an industrial use   U confirmed
to a more sensitive use (e.g. child care, educational, recreational or
residential purposes), then a detailed site history outlining previous
potentially contaminated uses on the premises                                 snot applicable




Privacy - please refer to your assessment manager for further details on the use of information recorded in
this form.


OFFICE USE ONLY

Date Received                              Reference Numbers


The Sustainable Planning Act 2009 is administered by the Department of Infrastructure and Planning. This form and
all other required application materials should be sent to your assessment manager and any referral agencies.




                                                                                            itamira!-m I 1-w ,l - IDAS form 24
                                                                                            Version 1.0 18 December 2009