Australian
   Capital Territory
      Government

OFFICE USE ONLY

Fees

____________________

Date Received

____________________

Receipt Number

____________________

Receiving Officer

____________________	
Land (Planning and Environment) Act 1991 – Form 6
        Application for Reconsideration

Original Development Application (DA)      __________________________________________
Part 1: Lessee/Site details:

If more than one lease/site, attach the following details for each lease/site.
	Block:  ________________________
	
Section:  __________________________

Unit (if applicable):  ________________
	
Suburb:  ______________________________________________________________________________

District:  ______________________________________________________________________________
	
Street Address:  ___________      Street Name:      _______________________________________
_______________________________________________________________________
Part 2:     Applicant details:
Surname:  ____________________________________________________________________________

First name: ___________________________________________________________________________

Company name:  _____________________________________________________________________

Australian Company Number:  _________________________________________________________

If a company, Name of Contact Person:_________________________________________________

Postal Address: _______________________________________________________________________

Suburb:  ______________________________________________________________________________

State/Territory:  ______________________________                   Postcode:  __________________

Phone Number (business hours):_______________________________________________________

Fax Number:  _________________________________________________________________________

Email:  _______________________________________________________________________________

                                                                                                                                                  App Reconsideration Approval  Form 6 – 07/04 Page 1          

All lessess must sign authorising the lodgement, and in doing so give authority to the applicant to negotiate any dealings with the application through to its determination by the relevant authority, or a Power of Attorney must be attached. If there are more than two lessees, please ensure that details and authorisation are attached to the application for each lessee.

If the lessee is a registered company, organisation or government agency you must execute this application in the proper manner for that company, organisation or government agency. For example, if the lessee is a community organisation, the full name of the community organisation must be stated and the signatory must  identify what position of authority he/she holds in the organisation.

To verify the signature of a lessee who is an organisation or government agency, a Letter of Authority must be supplied when lodging the application that empowers the signatory to sign on the behalf of that organisation or government agency.

Any application made over a site which has been Unit Titled will require Approval in accordance with the articles of association for that units plan.

	
Part 3:   Applicant’s declaration

I/we the undersigned, being the applicant(s) nominated in this application, hereby apply for reconsideration of the development application specified on this form;
I/we declare that all the information given on this form and its attachments is true and complete; and

I/we hereby authorise ACT  Planning and Land Authority Officers to access the subject property(s) for the purpose of evaluating the proposal.

CONFLICT OF INTEREST DECLARATION:       Does the applicant or lessee have any association with ACTPLA   staff?
							   No      Yes

If yes, please provide details:  _______________________________________________________________

___________________________________________________________________________________________

_______________________________________________________________________________________ 

_______________________________________________________________________________________

Signature(s):  _______________________________________    Date:  _______________________________

Part 4:     Lessee (Owner) details

1st  Lessee’s details  

	Surname or Company name:  ________________________________________________________	
Title / First Name / Initials or
	Australian Company Number (ACN): _________________________________________________

If a company Name of contact person:  _______________________________________________

Postal Address:  _____________________________________________________________________

Suburb:  _____________________________________________    State/Territory: _____________

Postcode:  _______________________________

Phone number (business hours): _____________________________________________________

Fax number:  _______________________________________________________________________

Email:  _____________________________________________________________________________

Signature(s):  _______________________________________________________________________

                                                                                  App Reconsideration Approval  Form 6 – 07/04 – Page 2               
Part 4:     Lessee (Owner) details     (continued)

2nd Lessee’s details                                    

	Surname or Company name:  ___________________________________________________________________________________

	Title / First Name / Initials or
	Australian Company Number (ACN): ____________________________________________________________________________

If a company Name of contact person:  __________________________________________________________________________

Postal Address:  _______________________________________________________________________________________________

Suburb:  ___________________________________________                   State/Territory:  ________________________________

Postcode:  _______________________________

Phone number (business hours): ________________________________________________________________________________

Fax number:  __________________________________________________________________________________________________

Email:  _________________________________________________________________________________________________________

Signature(s):  ___________________________________________________________________________________________________

Part 5:     Application for Reconsideration is being applied against

Please specify grounds on which reconsideration of the original decision is
sought.	
          Refusal of a Development Application

      Conditions of Approval (specify)

      __________________________________________________________________________________

      __________________________________________________________________________________

      __________________________________________________________________________________

Part 6:     Amendment/s

Have you amended your plan/s to support your application for reconsideration?

		  No      Yes   (please attach a copy of the amended plans)

If yes, describe the impact (if any) on other conditions of approval.

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

                                                       App Reconsideration Approval  Form 6 – 07/04 – page 3               

Privacy Notice

The personal information on this form is being collected to enable processing of your application. Collection of personal information is authorised by Part VI of the Land (Planning and Environment) Act 1991. The information that you provide may be disclosed to the ACT Revenue Office and the Registrar-General’s Office. The information may be accessed by ACTEWAGL Corporation and commercial organisations interesting in building information.

The Land (Planning and Environment) Act 1991 requires the details of applications, approvals and orders to be kept on a register and made available for public inspection.

Inspection of development applications may be made available via the internet.	

(ACTPLA) Contact Details:

ACT Planning and Land Authority
Customer Service Centre
GPO Box 1908, Canberra City 2601
16 Challis Street, Dickson ACT 2602
Business Hours: 8.30am to 4.30pm weekdays
Phone: (02) 6207 1923
Fax:  (02) 6207 1925
TTY: (02)  6207 2622
Email: actpla.customer.services@act.gov.au
Website: www.actpla.act.gov.au	

         

App Reconsideration Approval  Form 6 – 07/04 – Page 4