Australian
   Capital Territory
      Government

OFFICE USE ONLY

Fees

____________________

Date Received

____________________

Receipt Number

____________________

Receiving Officer

____________________	
Land (Planning and Environment) Act 1991 – Form 4

        Application for an Order

The questions we ask on this form are required under part VI division 6.3 of the Land (Planning and Environment) Act 1991.  We need this information to process your application.  How quickly we can process it depends on the information you give us and how accurate it is.
We may need to give this information to other government agencies in order to receive their comments before considering your application.  This information will also be made available to government agencies for statistical and administrative purposes and non government persons and organisations. 
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.

1.  Applicant details
Name of individual or organisation 

__________________________________________________________________________________
Postal address 

__________________________________________________________________________________
Street address (if different)

__________________________________________________________________________________
Contact Phone Number(s)

__________________________________________________________________________________

2.  Details of property to which your application refers

Block  ___________________      Section   ___________________       Unit  ___________________

Suburb  ______________________________________________________________________________

Street number and name  ________________________________________________________________

Order is sought against

      Lessee  _______         and/or Occupant    _______

Name and address of lessee/occupant (if known)

__________________________________________________________________________________

__________________________________________________________________________________
3.  Activity about which you wish an order to be made

Part VI and Schedule 5 of the Land Act provides that the following activities are subject to orders.  Please tick the space adjacent to the controlled activity.

____	Work affecting the requirement for the conservation of a heritage place

____	Failure to comply with a lease or development agreement

_____	Failure to keep a leasehold clean

_____ Undertaking development without approval as defined by Section 222 of the Land Act.
	This includes the unauthorised use of residential land for the carrying on of a profession, trade  
            occupation or calling
													                                                                           App Order  Approval  Form 4 – 07/04 - Page 1             

_____	Having a building or structure without the required approval.

_____	Permitting a tree, plant or shrub to obstruct or inconvenience a person in a public place

_____	An activity which is likely to cause soil erosion

_____	Failing to control animal or plant pests.

_____	Parking heavy vehicles on residential land in contravention of the code of practice.

_____	Managing rural land other than in accordance with a land management agreement

For a full description of activities which are subject to orders, reference should be made to Schedule 5 of the Land Act.

4.  The order you are seeking
Please tick the space adjacent to the order required in relation to the activity selected in section 3.

_____	Not to commence a development without approval               _____  Stop carrying out a development without approval

_____	Stop or not commence, a controlled activity other	          _____   Comply with the terms of an approval to undertake
	than a development				                       a development

_____	Stop undertaking a development otherwise than in	           _____  Demolish a building or structure, or a part of a
 	accordance with the conditions subject to which an		         building or structure, that has been constructed or
 	approval to conduct the development was given		        erected without approval or permission required by
									        an Act or regulations
_____	Demolish a building or structure, or a part of a
	building or structure, that encroaches onto, over or	           _____   Restore any land, building or structure that has been
 	under unleased Territory Land without approval		          altered without approval or permission required by
    granted under an Act					          an Act or regulations

_____	Replace with an identical building or structure any	            _____  Clean up a leasehold
 	building or structure that has been demolished
	without approval or permission required by an Act	            _____  Prune in a manner specified in the order so much of
 	or regulations						         a tree, sapling, plant or shrub as overhangs a public place

_____	Cease carrying out an activity that is likely to cause	            _____  To manage land held under a rural lease in
	soil erosion						          accordance with its land management agreement

5.  Your concerns
Please state what is presently occurring, and why you believe the Authority should make the order sought.

											App Order  Approval  Form 4 – 07/04 - Page 2            

         
 I/We declare that all the information I/we have given on this form and its attachments is true and complete.

6.  Signature of applicant         (An application fee is payable at the time of lodgement)

______________________________________     Date___ / ___ / _______

You may lodge your application by hand or make general enquiries at:	Or post your application to the ACTPLA at the following address
		
	ACT Planning and Land Authority					ACT Planning and Land Authority
	Customer Service Centre						Customer Service Centre
	16 Challis Street Dickson					GPO Box 1908
	Tel:  (02) 6207 1923						Canberra  ACT  2601	

Please note 
A copy of your application and any attachments will be sent by the Authority to the lessee/occupier of the land on which the activity is occurring and to the appropriate government agency.  These persons  may make submissions to the Authority.

                               App Order  Approval  Form 4 – 07/04 - Page 3