Change Application Form Little Sister

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    Yes - the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided with
this application.




E 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.



fl t agree to receive an information request if determined necessary for this change application
n t Oo not agree to accept an information request for this change application
Note: By not agreeing to accept an information request l, the applicant, acknowledge:
o that this change application wrl/ be assessed and decided based on the information provided when making this change application
   and the assessmenf m anager and any rcfenal 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 applicatian is an application listed under section 11.3 of the DA Rules.
Fufther advice abaut informatian requests is contained in the DA Forms Guide.




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


PAffiT $ * CHHEKLIST AruD APFLIEANT NMELARATi*FJ


I have identified the:
     .    responsible entity in 3); and
     .    for a minor change, any affected entities; and
     .    for an 'other' change all relevant referral requirement(s) in 9)
l/ofe: See the Planning Regulation 2017 for refenal requirements
For an 'other'change application, the relevant sections of DA Form 1 - Devetopment     Yes                        I
 details have been completed and is attached to this        application            ffiftot 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
                                                                                                                  I ves
completed and is attached to this application                                                                     druot 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                       J Yes
 result of the change apptication, a planning report and any technical repofts required by       the              M
relevant categoising instrument(s) (e.9. the local govemment planning scheme, State Planning
Policy, State Development Assessmenf Provisions). For fufther information, see DA Forms
Guide: Ptanning report template.
Relevant plans of the devetopment are attached to this development application
Note: Relevant plans are required to be submitted for all relevant aspecfs of fhis change
application. For further informatian, see DA Forms Guide: Relevant plans.




MpV mat ing this change application, t declare that all information in this change application is true and correct.
[fWnere an email address is provided in Part 1 of this form, I consent to receive future electronic communications from
the resoonsible entitv and anv relevant affected entitv or referral aqencv for the chanqe application where written

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                                                                                                         Planning Act Form 5 - Change application form
                                                                                                                              Version 1.0-3 July 2017