Change application form · 51987.3790.04

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

QLeave project number

Amount paid ($) Date paid (dd/mm/yy) |
Date receipted form sighted by assessment manager
Name of officer who sighted the form

 

 

 

 

 

 

 

 

 

Page 5
Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020