Combined IDAS Forms · MCU13/0171

    3.     Confirm the following mandatory requirements accompany this application
    Mandatory requirements                                                         Confirmation of       Method of
                                                                                   lodgement             lodgement

    In regard to 2(i) to 2(v)
    If the application involves a material change of use from an industrial use to a potentially sensitive material change of
    use
    A detailed site history outlining previous potentially contaminating uses      ✔   Confirmed         Electronic
    on the premises                                                                    Not applicable
    In regard to 2(vi)
    Where applicable, any existing report on prior investigation or                    Confirmed
    remediation of the premises by a UXO contractor or consultant                      Not applicable    Electronic
    accredited by the Department of Defence

    Mandatory supporting information

    4.     Confirm that the following mandatory supporting information accompanies this application
    Mandatory supporting information                                               Confirmation of       Method of
                                                                                   lodgement             lodgement

    For all applications

    A statement addressing the relevant part(s) of the State Development           ✔   Confirmed         Electronic
    Assessment Provisions (SDAP).                                                      Not applicable

    In regard to 2(i) to 2(v)

    Plans showing where any notifiable activities, hazardous contaminant or            Confirmed
    potentially contaminating activity has occurred on the premises
    In regard to 2(vi)
    Plans showing where excavation, earthworks or other disturbance of                 Confirmed         Electronic
    land associated with this development will occur relative to any part of           Not applicable
    the premises categorised by the Department of Defence as having a
    ‘substantial’ UXO potential

   Privacy—Please refer to your assessment manager, referral agency and/or building certifier 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 State Development, Infrastructure and
   Planning. This form and all other required application materials should be sent to your assessment manager and any
   referral agency.




Department of State Development, Infrastructure and Planning
PO Box 15009 City East Qld 4002
tel 13 QGOV (13 74 68)
[email protected]                                                                           IDAS form 24—Contaminated land
                                                                                                         Version 3.0—1 July 2013
www.dsdip.qld.gov.au