Planning Act Form 5 - Change application form · 51990.382.02

     such disclosure is in accordance with the provisions about public access to documents contained in the Planning
      Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and
      Planning Regulation 2017; or
     required by other legislation (including the Right to Information Act 2009); or
     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 8 – FOR COMPLETION OF THE ASSESSMENT MANAGER – FOR OFFICE
USE ONLY

 Date received:                                    Reference number(s):

 QLeave notification and payment
 Note: For completion by assessment manager if applicable
 Description of the work                                                       Patio Roof
 QLeave project number
 Amount paid ($)                                                               Date paid (dd/mm/yy)
 Date receipted form sighted by assessment manager
 Name of officer who sighted the form




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                                                                                                         Planning Act Form 5 - Change application form
                                                                                                                        Version 1.2 — 7 February 2020
                                 Liability limited by a scheme approved under Professional Standards Legislation.