Australian
Capital Territory
Government

OFFICE USE ONLY

Application number

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Date Received

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Receipt Number

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Receiving Officer

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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)

You may lodge your application by hand or make general enquiries at:
ACT Planning and Land Authority
Customer Service Centre
16 Challis Street Dickson
Tel:  (02) 6207 1923
Or post your application to the Authority at the following address
ACT Planning and Land Authority
Customer Service Centre
GPO Box 1908
Canberra  ACT  2601
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
•	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 than a development
•	Comply with the terms of an approval to undertake a development
•	Stop undertaking a development otherwise than in accordance with the conditions subject to which an approval to conduct the development was given
•	Demolish a building or structure, or a part of a  building or structure, that has been constructed or  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 under unleased Territory Land without approval granted under an Act
•	Restore any land, building or structure that has been altered without approval or permission required by an Act or regulations
•	Replace with an identical building or structure any building or structure that has been demolished without approval or permission required by an Act or regulations
•	Clean up a leasehold
•	Prune in a manner specified in the order so much of a tree, sapling, plant or shrub as overhangs a public place
•	Cease carrying out an activity that is likely to cause soil erosion
•	To manage land held under a rural lease in accordance with its land management agreement

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
				Date	/	/       
An application fee is payable at the time of lodgement

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