Type of Application
•	New Application		
(If you attended a pre-application meeting or received pre- application written advice- please provide the proposal number)	Insert Proposal Number to which this application relates (if applicable):

200………………..	
				
•	Amendment (Section 144)	
	
Amendment to a current application 
not yet approved	Insert Proposal Number to which this application relates: 

200………………..	
				
•	Amendment (Section 197)	
	
Amendment to a development approval 	Insert Development Approval Number to which this application relates: 

200………………..	
					
The following questions must be answered for amendments lodged under S.144 or S.19 7 of the P&D Act 2007

Will the development applied for after the amendment be substantially the same as the development applied for originally? 	
•	YES        	•	NO - If NO  - the Authority must refuse to amend the development application/approval	

Will the assessment track for the application change if the application is amended?  
	
•	NO        	•	YES - If YES - the Authority must refuse to amend the development application/approval	

•	Satisfying Conditions 
        of Approval (S.165)	
	
Information and documentation to satisfy conditions of development approval	Insert Proposal Number to which this application relates: 

200………………..	

Lease/Site Details Please Print
If more than one lease/site, attach the following details for each lease/site

Block	

Section	
	Unit (if applicable)		
		
Suburb	

District	

Street Number	

Street Name	

Postcode	

Applicant Details Please Print

Surname	
		First Name		
		
Company Name	

Position held in company			Australian Company Number (ACN)		
		
Postal Address	

Suburb	
		State			Postcode		
				
Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS	

Provision of Notice of Decision and Plans

Unless otherwise specified your notice of decision and/or plans will be returned via email

•	EMAIL		•	POST TO ME		•	HOLD FOR COLLECTION	

Lessee (Property Owners) Details Please Print

1st Lessee’s Details (or Government Land Manager)

Surname	
		First Name		
		
Company Name	

Position held in company			Australian Company Number (ACN)		
		
Postal Address	

Suburb	
		State			Postcode		
				
Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS	

All lessees must sign authorising the lodgement of this development application. In doing so the lessee gives authority to the applicant to negotiate any dealings in relation to the application through to its determination.  If there are more than two lessees please ensure that the details and authorisation are attached to the application.

Lessee (Property Owners) Details continued 

2nd Lessee’s Details (or Government Land Manager)

Surname	
		First Name		
		
Company Name	

Position held in company			Australian Company Number (ACN)		
		
Postal Address	

Suburb	
		State			Postcode		
				
Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS	

Fully Describe Your Proposal or List Amendments

EXAMPLE: New Child care facility, bulk landscape supplies facility

	

	

	

Use of the Land 

Describe the use of the land or the use of a building or structure on the land.
Example: Office, childcare facility, gymnasium

Is the Use consistent with the current Crown lease?
	•	YES 	•	NO	
Date Crown lease was granted	

Development Applications for Development Without Approval (S.205)

Is this application for development undertaken without approval?
	•	NO
•	YES	

If YES – A plan of the development prepared and signed by a registered surveyor that sets out the dimensions of the development must be submitted with this application.

Assessment Track, Zone, Development/Precinct Code

Please indicate which assessment track applies to this development application

•	CODE		•	MERIT		•	IMPACT	

NOTE: The Planning and Land Authority may refuse to accept a development application made in an incorrect assessment track.  If the Planning and Land Authority assesses an application made in the incorrect assessment track it must refuse the application (S.114 (3))

Please specify which Zone applies to this application: 				

Please specify which development/precinct code applies to this application:	

Type of Development

Please indicate which type of development applies to this development application

•	Non Residential
including commercial & industrial
	•	New Building
•	Addition/Alteration to existing
		
•	Community Use
including institutional
	•	New 
•	Addition/Alteration to existing
		
•	Lease Variation	•	Clause Changes
•	Consolidation
•	Subdivision
•	Other ___________________	•	Encroachment
•	Land Rent Payout
	
•	Public Works 
Includes roads, stormwater drainage, parks, electricity, gas, water, sewerage, telecommunications	
•	Rural
	
•	Signage	
		
•	Other (please specify) ______________________________	

Cost of Works

Please note that the estimated cost of work must include the cost of all associated works such as landscaping, parking, etc. as well as off site works.

What is the estimated cost of the development as calculated in accordance with the Building (Cost of Building Work) Declaration 2006?
	
$                  .00	
Existing Gross Floor Area
And /or	____________m2
	
Added Gross Floor Area
And/or	____________m2
	
Gross Floor Area to be demolished
	____________m2	
TOTAL Gross Floor Area
	____________m2	
The Building (Cost of Building Work) Declaration 2006 can be located on the Authority website – www.actpla.act.gov.au

Entity and/or Referral Requirements

Demolition 

A.	Is demolition work part of the application?	•	NO
•	YES	
IF NO	Go to next question	
IF YES	Go to Part B	

B.	Have you provided the ‘Statements of Endorsement’ from all relevant utility providers?	•	NO
•	YES	
IF NO	Go to Part C	
IF YES	Go to next question	

C.	Have you provided the necessary information as outlined in the development codes, in your documentation so your proposal can be referred to all relevant utility providers?		•	NO
•	YES	
Heritage

A.	Is the application for a development on land or buildings subject to interim or full heritage registration under the Heritage Act 2004?	•	NO
•	YES	
IF NO	Go to next question	
IF YES	Go to Part B	

B.	Have you provided a letter of advice from the Heritage Council?	•	NO
•	YES	
IF NO	Go to Part C	

C.	Have you provided the necessary information in your documentation so your proposal can be referred to the Heritage Council?	•	NO
•	YES

Trees

A.	Is the application for a development where groundwork is required within the Tree Protection Zone of a Protected Tree or is likely to cause damage to or removal of, any Protected Trees under the Tree Protection Act 2005?
	•	NO
•	YES	
IF NO	Go to next question	
IF YES	Go to Part B	

B.	Have you provided a Tree Management Plan, approved under the Tree Protection Act 2005?	•	NO
•	YES	
IF NO	Go to Part C	

C.	Have you provided the necessary information in your documentation so your proposal can be referred to the relevant agency?	•	NO
•	YES	

Hazardous Materials

A.	Does the application include the demolition of multi-unit housing (including garages and carports) constructed* prior to 1985, or Commercial / Industrial premises constructed prior to 2005?
* construction date - the date when the Certificate of Occupancy was issued
	•	NO
•	YES	
IF NO	Go to next question	
IF YES	Go to Part B	
			
B.	Have you provided a Hazardous Materials Survey endorsed by Environment Protection?	•	NO
•	YES	
IF NO	Go to Part C	

C.	Have you provided the necessary information in your documentation so your proposal can be referred to the relevant agency?	•	NO
•	YES	

Contamination

A.	Have you provided a Statement of Endorsement from the relevant agency, which states that the potential for land contamination has been assessed in accordance with ACT Government Strategic Plan – Contaminated Sites Management 1995 and the ACT Environment Protection Authority Contaminated Sites Environmental Protection Policy 2000?
	•	NO
•	YES	
IF YES	Go to next question	
IF NO	Go to Part B	

B.	Have you provided the necessary information in your documentation so your proposal can be referred to the relevant agency?	•	NO
•	YES	

Erosion and Sediment Control

A.	Is the site greater than 0.3 of a hectare?
	•	NO
•	YES	
IF NO	Go to part B	
IF YES	Go to Part D	

B.	Have you provided a plan that demonstrates that the development complies with the ACT Environment Protection Authority, Environment Protection Guidelines for Construction and Land Development in the ACT, August 2007?
	•	NO
•	YES	
IF YES
IF NO	Go to next question
Go to Part C	
			
C.	Have you provided the necessary information in your documentation so your proposal can be referred to the relevant agency?
	•	NO
•	YES	
IF YES	Go to Next Question	

D.	Have you provided an Erosion and Sediment Control Plan endorsed by ACT Environment Protection?
	•	NO
•	YES	
IF NO	Go to part E	
IF YES	Go to next question	
						
E.
.	Have you provided the necessary information in your documentation so your proposal can be referred to the relevant agency?	•	NO
•	YES	

Noise (Required for Industrial Zones Only)

A.	Does your development include a club, drink establishment, hotel, industry (except light industry), indoor entertainment facility, or restaurant?
	•	NO
•	YES	
IF NO	Go to next question	
IF YES	Go to Part B	

B.	Have you provided a Noise Management Plan that has been endorsed by Environment Protection Authority? 
	•	NO
•	YES	
IF NO	Go to Part C	

C.	Have you provided a Noise Management Plan prepared by an accredited acoustic specialist who is a member of the Australian Acoustic Society which addresses ways of minimising the impact of noise on neighbours for referral to the relevant agency?	•	NO
•	YES	

Waste Management for Waste Facilities and Management

A.	Does the development require a “Statement of Compliance” from Territory & Municipal Services stating that waste facilities and management associated with development are in accordance with the Development Control Code for Best Practice Waste Management in the ACT 1999?
	•	NO
•	YES	
IF NO	Go to next question	
IF YES	Go to Part B	

B.	Have you provided the “Statement of Compliance” for waste facilities and management from the Department of Territory and Municipal Services? 
	•	NO
•	YES	
IF NO	Go to Part C	

C.	Have you provided the necessary information in your documentation so your proposal can be referred to Department of Territory and Municipal Services?	•	NO
•	YES	

Waste Management - Liquid Trade Waste (Required for Industrial Zones Only)

A.	Does the development require discharge (or have the potential for discharge by accident or spillage) of non-domestic liquid waste to the sewerage or stormwater?	•	NO
•	YES	
IF NO	Go to next question	
IF YES	Go to Part B	

B.	Have you provided the “Statements of Compliance” for liquid trade waste from the relevant agencies? 
	•	NO
•	YES	
IF NO	Go to Part C	

C.	Have you provided the necessary information in your documentation so your proposal can be referred to the relevant agencies?	•	NO
•	YES	

Servicing and Site Management

A.	Does the development require waste facilities?	•	NO
•	YES	
IF NO	Go to next question	
IF YES	Go to Part B	

B.	Have you provided the “Statement of Endorsement” from the relevant agency? 
	•	NO
•	YES	
IF NO	Go to Part C	

C.	Have you provided the necessary information in your documentation so your proposal can be referred to the relevant agency?	•	NO
•	YES	

Utilities

A.	Does the development include earthworks, utility connections, buildings, pavement or landscape features?	•	NO
•	YES	
IF NO	Go to next question	
IF YES	Go to Part B	

B.	Have you provided the “Statement of Compliance” from each of the relevant utility providers (for water, sewerage, stormwater, electricity and gas)?
	•	NO
•	YES	
IF NO	Go to Part C	

C.	Have you provided the necessary information in your documentation so your proposal can be referred to the relevant agency?	•	NO
•	YES	

Information Requirements for Development Applications (Non Referral Matters)

Subdivision (Other than Residential Zones)

A.	Does the development include subdivision?	•	NO
•	YES	
IF YES	Go to Part B	
IF NO	Go to next question	

B.	Have you demonstrated that the subdivision and the building on any consequent lease can be designed in accordance with the relevant section of the development code?
	•	NO
•	YES	
	Go to Part C	

C.	If subdivision is proposed under the Unit Titles Act 2001 does the lease expressly provide for the number of units or dwellings in the proposed subdivision? 	•	NO
•	YES	
	
Go to Part D
					
D.	Have you demonstrated that the residual block can accommodate another assessable development designed in accordance with the relevant sections of this code?	•	NO
•	YES	

Location Requirements (Required for Community Facility and Parks & Recreation Zones Only)

A.	Have you provided evidence that demonstrates the development meets the requirements of the Community and Recreation Facilities Location General Code?
	•	NO
•	YES	

Plans of Management (NOT required for Industrial and Community Facility Zones)

A.	Have you provided evidence regarding consistency with all relevant
Plans of Management?	•	NO
•	YES	

National Capital Plan

A.	Is the development subject to Special Requirements under the National Capital Plan (including any relevant Development Control Plan)?
	•	NO
•	YES	
IF YES	Go to Part B	
IF NO	Go to next question	

B.	Have you provided evidence that addresses the requirements of the National Capital Plan?	•	NO
•	YES	

Crime Prevention Through Environmental Design

A.	Is your development type listed in Table 1 of the Crime Prevention Through Environmental Design General Code?
	•	NO
•	YES	
IF YES	Go to Part B	
IF NO	Go to next question	

B.	Have you provided evidence that addresses the requirements of the Crime Prevention Through Environmental Design General Code?
	•	NO
•	YES	

Access and Mobility

A.	Is the development type listed in Table 1 of the Access and Mobility General Code?
	•	NO
•	YES	
IF YES	Go to Part B	
IF NO	Go to next question	

B.	Have you provided evidence that addresses the requirements of the Access and Mobility General Code?
	•	NO
•	YES	

Traffic Generation (NOT required for Industrial and Non Urban Zones)

A.	Can the road network accommodate the amount of traffic likely to 
be generated by the development?
	•	NO
•	YES	
	Go to Part B	

B.	Have you provided estimates of the traffic that is likely to be generated by the development?	•	NO
•	YES	

Site Access

A.	Does site access comply with the requirements of the Parking and Vehicular Access General Code?
	•	NO
•	YES	
	Go to Part B	

B.	Have you provided evidence demonstrating the site access complies with the Parking and Vehicular Access General Code?	•	NO
•	YES	

Parking (Car)

A.	Does car parking comply with the requirements of the Parking and Vehicular Access General Code?
	•	NO
•	YES	
	Go to Part B	

B.	Have you provided evidence demonstrating the site access complies with the Parking and Vehicular Access General Code?	•	NO
•	YES	

Parking (Bicycle)

A.	Does bicycle parking comply with the requirements of the Bicycle Parking General Code?
	•	NO
•	YES	
	Go to Part B	

B.	Have you provided evidence demonstrating the bicycle parking arrangements meet the Bicycle Parking General Code?	•	NO
•	YES	

Landscape (Required for Industrial Zone Only)

A.	Have you provided documented landscape design concepts that addresses all of the requirements contained in the Development Code?
	•	NO
•	YES	

Lighting

A.	Is external lighting provided to building frontages, to all pathways, roads, laneways, and car parking areas in accordance with Australian Standard AS 1158.1.3 Pedestrian Lighting?
	•	NO
•	YES	
IF YES	Go to Part B	
IF NO	Go to Part C	

B.	Is evidence provided demonstrating that this lighting is in accordance with Australian Standard AS 1158.1.3 Pedestrian Lighting?
	•	NO
•	YES	
	Go to Part C	

C.	Is the external lighting in accordance with the Crime Prevention Through Environmental Design General Code?	•	NO
•	YES	
	Go to Part D					

D.	Have you provided evidence that demonstrates the external lighting is in accordance with the Crime Prevention Through Environmental Design?	•	NO
•	YES	

Signs

A.	Does the application include any Signage?	•	NO
•	YES	
IF YES	Go to Part B	
IF NO	Go to next question	

B.	Have you provided evidence that demonstrates the proposed signage meets the requirements of the Signs General Code?	•	NO
•	YES	

Neighbourhood Plans (Required for Community Facility and Parks and Recreation Zones Only)

A.	Are any Neighbourhood Plans applicable to your development?	•	NO
•	YES	
IF YES	Go to Part B	
IF NO	Go to next question	

B.	Have you provided evidence that demonstrates the development meets the requirements of the Neighbourhood Plan?	•	NO
•	YES	

Assessment of Environmental Effects 
(Required for Parks & Recreation Transport & Services and Non Urban Zones Only) 

A.	Have you provided an ‘Assessment of Environmental Effects’ that addresses all of the requirements contained in the Development Code?	•	NO
•	YES	

Water Sensitive Urban Design (Mains Water Consumption) 

A.	Have you provided evidence the development achieves a minimum 40% reduction in mains water consumption?	•	NO
•	YES	

Water Sensitive Urban Design (Stormwater Quality) (Not required for Non Urban Zone)

A.	Is the development on a site less than 2000 m2?	•	NO
•	YES	
IF YES	Go to Part B	
IF NO	Go to Part C	

B.	Have you provided evidence that demonstrates a reduction of 1-in-3 month stormwater peak run off flow to pre-development levels with release of captured flow over a period of 1 to 3 days is achieved?	•	NO
•	YES	
	Go to Part C	

C.	For sites greater than 2000 m2
Have you provided evidence that demonstrates a reduction in average annual stormwater pollutant export load?
	•	NO
•	YES	

Water Sensitive Urban Design (StormwaterQuantity) (Not required for Non Urban Zone)

A.	Have you provided evidence that the development achieves stormwater reduction quantities as prescribed in the relevant Development Code? 	•	NO
•	YES	

Water Use – where applicable (Required for Parks & Recreation and Non Urban Zones Only)

A.	Have you provided evidence that demonstrates compliance with the Water Use and Catchment General Code
	•	NO
•	YES
•	Not applicable	

If you have ticked Not Applicable please explain:

__________________________________________________________________________________________

Bushfire Risk Management – where applicable (Required for Non Urban Zone Only)

A.	Have you demonstrated that the development complies with the Planning for Bushfire Risk Mitigation General Code?
	•	NO
•	YES
•	Not applicable	

If you have ticked Not Applicable please explain:

__________________________________________________________________________________________

Driveways

For proposals that include construction or modification of driveway/s please indicate works to be undertaken:	
•	Not applicable	•	Construction of additional entrance	
•	Relocation of existing entrance	•	Construction other than plain concrete	
•	Construction of new driveway	•	Other (please specify) ____________________	

Survey Requirements - S139 (2)(J)

If this application is for approval of a development that requires construction work to be carried out on land that has previously been developed and is not leased for rural purposes a survey certificate for the land where the development is to be carried out prepared and signed by a registered surveyor must accompany this application (unless exempt by Regulation 25 of Planning and Development Regulations 2008).

Have you provided a survey certificate with this application?		•	YES
•	NO
•	EXEMPT	

Exclusion from Public Inspection

In accordance with the requirements of Sections 28 and 30 of the Planning and Development Act 2007 the 
ACT Planning and Land Authority must make the details and associated documents relevant to a development application available for public inspection.

If you wish to apply to have all or part of this development application excluded from public inspection you must meet the requirements of Section 411(5) or 412(1) of the Planning and Development Act 2007.

Exclusion from Public Inspection Requested	•	YES
•	NO	
		
If Yes – please indicate under which section of 
Planning & Development Act 2007	•	S.411(5)  Restriction on Public Availability
•	*S.412(1) Restriction on Public Availability 
                     SECURITY

Please specify the information to be excluded from public inspection and provide reasons for exclusion:

* if exclusion is requested under Section 412(1) a letter, signed by a justice Minister, certifying this request satisfies the requirements Planning and Development Act 2007 must accompany this application.

Conflict of Interest Declaration

Does the applicant or lessee have any association with ACT Planning and Land Authority staff?	•	NO
•	YES	
If YES - please provide details:	

NOTE: There are penalties for deliberately giving false and misleading information. The Planning and Land Authority or Minister may revoke an approval if satisfied that the approval was obtained by fraud or misrepresentation.

Other Development Application Requirements

LODGEMENT & PAYMENT

A valid development application comprises of a completed development application form accompanied by all of the required information or documents that address the relevant rules and/or relevant criteria for it to be considered for approval.

Proposals in the Code track must be accompanied by information or documents addressing all the relevant rules, including all statements of endorsement required for the application.  If the information is not provided the application must be refused.

Proposals in the Merit track have the option to comply with the rules or criteria, unless the rule is mandatory.  Where it is proposed to meet the criteria, the onus is on the applicant to demonstrate, by supporting plans and written documentation, that the proposed development satisfies the criteria and therefore the intent of the element. 

Proposals in the Impact track also have the option to justify any non-compliance with the rules and the criteria, unless the rule is mandatory.  Where it is proposed to not meet the rules and the criteria, the onus is on the applicant to justify the non-compliance by demonstrating that the proposed development is consistent with the relevant principles of the Statement of Strategic Directions.  Supporting plans and written documentation, providing consideration of the relevant Intents of the Code and the Zone objectives, are to accompany the development application. 

Once a development application is received, the documentation will be checked to ensure it meets the standard for lodgment.  If the documentation provided is acceptable, you will receive written confirmation the application is ready for lodgment and a request for the payment of the application fees. A development application is not considered lodged until full payment of fees is made.

If the DA documentation is not acceptable for lodgment, you will receive written advice detailing the additional information required and/or any other issues with your application. Once these things are provided the Authority will recommence the documentation check and fee payment process outlined above.

All required documentation must be provided in an electronic format on compact disc/DVD and meet the following requirements (DA form to be lodged in hardcopy if submitted over the counter)

•	Each document must be saved as a PDF and named in accordance with the naming convention as detailed on the ACTPLA website. 
•	All plans must be to scale.
•	All plans must be rotated to landscape.
•	All plans are to be clear and concise and consistent with Australian Standard 1100.301 - 1985 and Australian Standard 1100.301 supplementary - as updated from time to time.
•	The proposal number included in the naming convention is unique to the application and provided by the ACT Planning and Land Authority. If you have already had dealings with the Authority about your proposal through a pre-application meeting or have requested and received pre application advice, you would already have a proposal number allocated for your development application. If you have not been allocated a proposal number, leave this number out of the file name. 
•	The documentation provided on CD/DVD either over the counter or via an electronic lodgment process (email or internet) will be considered to be the relevant documentation associated with this application.

HARDCOPY DOCUMENTATION REQUIREMENTS

In addition to DA documentation being provided on compact disc/DVD a hard copy must also be provided for the following:
•	Any report required as part of an application over 20 pages in length
•	ALL development applications that will be assessed in the IMPACT assessment track
•	development applications for:
o	a residential building intended to be higher than 3 storeys and consisting of more than 50 units
o	a building where the total floor space of which is intended to be more than 7000m2
o	a building or structure intended to be higher than 25m
o	an application to change a concessional lease into a lease that is not concessional

Amendment to Development Application Not Yet Approved (s.144)
When submitting documentation or plans in relation to an amendment to a development application that has not been determined, a written statement specifying what elements of the original proposal have been changed must be provided.

Further Information (S.141) (not applicable to Code track applications)
In addition to the documentation provided at the time of lodgment the Authority may, by written notice, request more information from the applicant under section 141 of the Planning and Development Act 2007 at any time after the lodgment of the development application.

Satisfying Conditions of Approval (S.165)
When submitting documentation or plans to satisfy conditions of approval a written statement detailing which conditions the documentation or plans are seeking to satisfy must be provided.

Amendment to Development Approval (S.197)
When submitting documentation or plans in relation to an amendment to a development approval, a written statement specifying what elements of the original approval have been changed must be provided.  The amended application may need to be notified (S.198).

Changes to a Unit Development
Your building work may have an effect on the Unit Entitlements of the Units Plan. You may require a statement from a certified valuer as to this effect. For further information please contact the Authority.

Applicant and Lessee Declaration

I/we the undersigned, hereby apply for approval to carry out the development described on the land specified in this application;

I/we declare that this application is accompanied by all of the required information or documents that address the relevant rules and/or relevant criteria for it to be considered for approval;

I/we understand that if during the assessment of this application it is found to have been submitted in the incorrect assessment track the application will be refused and I/we will not be entitled to a refund or transfer of fees;

I/we understand that the information submitted with this application form will undergo a documentation check prior to the payment of fees and formal lodgement of the application.  Further information may be required prior to the acceptance of the development application by the Authority;

I/we understand that the documentation provided on CD/DVD or via the electronic lodgment process will be considered to be the relevant documentation associated with this application. If only hard copy plans are provided at the time of lodgement they will be electronically scanned.  All development application documentation will be made available for public inspection including via the Internet unless exclusion has been approved;

If the time for deciding the application (prescribed period) has ended and a decision has not been reached I/we understand that the application will be deemed refused and the ACT Planning and Land Authority will not provide written advice of this decision.  I/we also understand that the ACT Planning and Land Authority is able to still consider the application and make a decision after the expiration of the prescribed period.

I/we hereby authorise the ACT Planning and Land Authority its servants and agents to erect sign/s on the subject property(s) as required;

I/we hereby authorise ACT Government officers to access the subject property(s) for the purpose of evaluating the proposal (including the inspection of driveways and trees);

I/we the undersigned (lessee) appoint the applicant whose signature appears below to act on my/our behalf in relation to this Development Application. This authorises the applicant to pay all application fees, bonds and securities, liaise with the ACT Planning and Land Authority when required, alter, amend or provide further information as necessary and receive any communications relating to this Development Application.

I understand that all costs including the relocation of any engineering services (light poles, storm water, sumps etc) will be at my expense and that I will indemnify the ACT Government, its servants and agents against any claims arising during construction;

I understand that construction of any driveway associated with this application may not commence until the contractor has received endorsement by the relevant government entity. 

I understand that a Certificate of Design Acceptance and a Road Opening Permit and Temporary Management Plan must be obtained from the relevant government agencies prior to the start of construction works.

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

If signing on behalf of a company, organisation or Government agency: -
I/we the undersigned, declare I/we have the appropriate delegation or authority to sign on behalf of the company, organisation or Government agency.

Applicant Signature (s)	
	Date		
				
1st Lessee’s Signature	
	Date		
				
2nd Lessee’s Signature	
	Date		
				
Govt Land Managers Signature 
(unleased land only)	

	Date		
				
Delegate of ACTPLA 
(unleased land only)	

	Date		

Privacy Notice
The personal information on this form is being collected to enable processing of your application. Collection of personal information is authorised by Chapters 7, 8 and 9 of the Planning and Development Act 2007. 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 other government agencies, ACTEWAGL, ACTEW Corporation and other commercial organisations interested in development and building information. The Planning and Development Act 2007 requires the details of applications, decisions and orders to be kept on a register and made available for public inspection. Information and documentation relevant to a development application may be made available via the Internet.

Does the Commonwealth Environment Protection and Biodiversity Conservation Act 1999 (EPBC) affect your proposal
The EPBC came into operation on 16 July 2000. It establishes an environmental assessment and approval system that is separate and distinct from the ACT system. It does not affect the validity of ACT development assessment and approval processes. The ACT cannot provide preliminary advice on whether a proposal falls within the definition of a controlled action, or requires referral to the Commonwealth. For information about the EPBC, including the referral process and when a referral should be made, contact: Environment Australia’s Community Information Unit, GPO Box 787, CANBERRA ACT 2601 Telephone: 1800 803 772

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 (excluding Public Holidays)
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

DOCUMENTATION REQUIREMENTS`
Industrial Zones, Community Facility Zones, Parks & Recreation Zone, 
Transport & Services Zone, Non Urban Zone
Key:

•	Required
 w   Required if relevant
   􀃅   May be requested as further information 
        (for merit & impact track assessable Development Applications only)	INDUSTRIAL	COMMUNITY USE	RURAL	Public Works & DAs  for Urban Open Space & Parks & Recreation Zones	Lease Variation ONLY	SIGNS	
List of all submitted drawings and documents	•		•		•		•			•		
Site Plan	•		•		•		•			•		
Floor Plan 	•		•		w	w		•		
Elevations	•		•		w	w		w	
Sections	•		•		w	w		•		
Colour Sample Schedule and Sample Board	w	w		w		w	
Demolition Plan (if relevant)	w	w	w	w		w	
Statement Against Relevant Criteria 
For merit & impact track assessable Development Applications only	•		•		•		•			•		
Survey Certificate
Required unless exempt by P & D Regulation 25	•		•		•		•			w	
Survey Plan 
Required for development undertaken without approval	w	w	w	w		w	
Landscape Plan	􀃅	􀃅	􀃅	􀃅		􀃅	
Full Valuation Report	w	w	w		•			
Valuation Certificate (for public register)	w	w	w		•			
List of Interested Parties including all names and addresses or Statement advising no interested parties
(includes mortgagee, sub-lessees etc)	w	w	w		•			
Drawings or Documents to support proposed lease use 
(where required)	w	w	w		w		
Draft Survey Plan 
(for subdivision or consolidation only)	w	w	w		w		
For Lease Variations In Units Plans
•	Letter detailing change to schedule of Unit Entitlements prepared by Valuer
•	Change to schedule of Unit Entitlements (Form 2 – Units Plan)
•	Evidence of unanimous resolution by owners’ corporations
 	w	w	w		w		
Relevant Entity Advice
Mandatory for DAs to be assessed in Code track
Optional for DAs to be assessed in Merit or Impact tracks	w	w	w	w	w	w	
Documentation to satisfy relevant entity referral and non referral requirements as required by the Territory Plan (as per responses to entity referral and non referral matter questions in this DA form)	w	w	w	w	w	w	
Completed Environmental Impact Statement	w	w	w	w	w		

Documentation Requirements Checklist

This checklist must be completed and submitted as part of your development application.  The applicant is required to confirm, in the appropriate column, that all required information has been provided.  

PREFERRED FORMAT FOR ALL DRAWINGS AND DOCUMENTS

Compact disc/DVD 
•	Saved as a PDF and named in accordance with the naming convention as detailed on the ACTPLA website. 
•	All plans must be to scale and rotated to landscape.
•	All plans to be consistent with Australian Standard 1100.301 - 1985 and Australian Standard 1100.301 supplementary - as updated from time to time.

Hardcopy documentation requirements
In addition to DA documentation being provided on compact disc/DVD a hard copy must also be provided for the following:

•	Any report required as part of an application over 20 pages in length 
•	ALL development applications that will be assessed in the IMPACT assessment track
•	Development Applications for:
o	a residential building intended to be higher than 3 storeys and consisting of more than 50 units
o	a building where the total floor space of which is intended to be more than 7000m2
o	a building or structure intended to be higher than 25m
o	an application to change a concessional lease into a lease that is not concessional

Submission Requirement
	Required information	Applicant Use	Office Use	
List of Submitted Drawings and Documents
	Preferred Format:	
A4 black and white	

Minimum Content:	
•	Each drawing is to be allocated a consecutive number or code
•	Subsequent amendments are to be noted and dated, and the amendment number appended to the drawing number or code

	

Not applicable

Supplied

•		
Statement Against Relevant Criteria
MERIT & IMPACT TRACK ONLY	Preferred Format:	
A4 black and white	

Minimum Content:	
Merit
•	Where it is proposed to meet a criteria the applicant is to provide a written statement demonstrating that the proposed development satisfies the criteria and therefore the intent of the element
Impact
•	Where it is proposed to meet a criteria the applicant is to provide a written statement demonstrating that the proposed development satisfies the criteria and therefore the intent of the element
•	Where a proposal does not meet the rules or the criteria the applicant to provide a written statement justifying the non-compliance and demonstrating that the proposed development is consistent with the relevant principals of the Statement of Strategic Directions

	
Not applicable

Supplied

•		
SECTION 144 Statement	Preferred Format:	
A4 black and white	

Minimum Content:	
•	A written statement specifying what elements of the original proposal have been changed

	

Not applicable

Supplied

•		

Submission Requirement
	Required information	Applicant Use	Office Use	
SECTION 165 Statement	Preferred Format:	
A4 black and white	

Minimum Content:	
•	A written statement detailing which conditions the documentation or plans are seeking to satisfy

	

Not applicable

Supplied

•		
Floor Plan(s)
For assessment purposes
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:100	

Minimum Content:	
•	A plan for each floor including any trafficable  subfloor areas
•	Dimensions
•	Key to sections cross referenced to relevant drawing and sheet number
•	Finished floor levels related to Australian Height Datum
•	Schedule of gross floor area for each floor
•	Identification of all adaptable dwellings
•	For proposals involving alterations or additions to an existing 
•	building, identification of the existing building
•	Identification of all rooms (existing and proposed)

	
Not applicable

Supplied

•		
Floor Plan(s)
For public register and notification purposes	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:100	

Minimum Content:	
As above with the following exceptions -
•	Floor plan is not to show interior layout of residential development
•	All windows and doors to be clearly marked to enable identification of the use of the room/space  to which they relate

	

Not applicable

Supplied

•		
Site Plan
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:200	

Preferred Contour Interval:	
250mm for urban areas, as appropriate for other areas	

Datum:	
Australian Height Datum (AHD)	

Minimum Content:	
•	Location and identification of existing structures and trees - tree canopies to be shown to scale
•	Boundaries of the site with bearings and distances
•	Location of proposed buildings and structures with dimensions to block boundaries
•	Schedule of gross floor areas for the proposal including existing structures
•	Existing contours from site survey of the site and adjoining verge
•	All easements on the land
•	Driveway verge crossing details
•	Where they can be reasonably determined, all existing reticulated services and associated infrastructure on the site
•	Street trees, foot paths, kerbs, storm water pits, street lighting and other public assets in the verge adjacent to the site
•	The drip line of any street tree where a proposed driveway verge crossing encroaches within that drip line
•	All proposed signs

	
Not applicable

Supplied

•		

Submission Requirement
	Required information	Applicant Use	Office Use	
Elevations
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:100	

Minimum Content:	
•	Dimensions including overall dimensions
•	Dimensioned heights including overall heights · 
•	Natural and finished ground levels related to Australian Height Datum
•	Finished floor levels related to Australian Height Datum
•	All proposed signs
•	Proposed external materials referenced to Colour Sample Schedule

	
Not applicable

Supplied

•		
Section(s)
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:100	

Minimum Content:	
•	Finished floor levels and ceiling levels
•	Natural and finished ground levels related to Australian Height Datum
•	Floor to ceiling heights
•	Side and rear building envelopes 
•	Long section of any proposed basement ramp showing gradients
•	Section of any sub floor areas

	
Not applicable

Supplied

•		
Site Analysis Plan	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:100	

Minimum Content:	
Site analysis plan must demonstrate that site layout and building design:
a) Compliments:
•	existing or future planned built form, in terms of scale, character and massing, in the locality
•	landscape character, achieved through attention to silhouette, pattern, texture and colour
•	residential identity
•	streetscape character and functions
•	existing important site features
•	heritage places AND
b) Integrates with the surrounding environment through:
•	adequate pedestrian, cycle and vehicle links to street and open space networks
•	dwellings face the street and public open spaces
•	clear definition of the public and private realm	

Not applicable

Supplied

•		
Driveway Plan
	Preferred Format:	
A3 (portrait) black and white	

Preferred Scales:	
1:200	

Minimum Content:	
•	Existing ground levels and the datum mark used to obtaining levels
•	Type of kerb & gutter i.e. layback or vertical
•	Existing or intended footpaths & their alignment
•	Kerb levels at each corner of the driveway
•	Levels of each side of the driveway 2m behind the kerb and property boundary
•	Longitudinal sections
•	Location & surface levels of proposed garage and/or carport and dwelling
•	Long sections
•	Distance from kerb line to garage or carport, kerb line to property boundary, changes to levels along each side of the proposed driveway at all changes of grade and at start, midpoint and finish of all vertical curves
•	Driveway to be outside tree canopy (for both leased land & verge) & anticipated mature canopy, 1.2 metres clear of sumps and services, 1.5 metres clear of transformers, 6 metres clear of tangent point on corner block
•	Proposed uphill grade to be less than 17% & downhill grade less than 12% on verge & at right angle to Kerb line (max 1:10 deviation)

	
Not applicable

Supplied

•		

Submission Requirement
	Required information	Applicant Use	Office Use	
Colour Sample Schedule and Sample Board
	Preferred Format:	
A4, A3, colour	

Minimum Content:	
•	Proposed external material colour schedule referenced to their location and use (e.g., roofing, windows, exterior walls) on elevations 
•	Schedule to identify names, codes and brands of exterior colours for materials as well as samples

	

Not applicable

Supplied

•		
Survey Certificate
(as required by Section 139(j) Planning & Development Act 2007)	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:200	

Preferred Contour Interval:	
250mm for urban areas, as appropriate for other areas	

Datum:	
Australian Height Datum (AHD)	

Prepared By:	
Registered Surveyor	

Minimum Content:	
•	The boundaries of the site with bearings and distances
•	The location of each building and structure on the site
•	Existing contours of the site and adjoining verge
•	Signed by registered Surveyor

	
Not applicable

Supplied

•		
Survey Plan 
(as required by Section 139(k) Planning & Development Act 2007)
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:200	

Preferred Contour Interval:	
250mm for urban areas, as appropriate for other areas	

Datum:	
Australian Height Datum (AHD)	

Prepared By:	
Registered Surveyor	

Minimum Content:	
•	The boundaries of the site with bearings and distances
•	The location of each building and structure on the site
•	Existing contours of the site and adjoining verge
•	All easements on the land
•	Where they can reasonably be determined, all existing reticulated services and associated infrastructure on the site
•	Street trees, driveway verge crossings, footpaths, Kerbs, stormwater pits, street lighting other public assets in the verge adjacent to site
•	Signed by registered Surveyor

	
Not applicable

Supplied

•		
Demolition Plan
	Preferred Format:	
A3 (A1 for large or complex proposals) black & white	

Preferred Scales:	
1:200	

Minimum Content:	
•	Identification of all buildings and structures proposed to be demolished

	

Not applicable

Supplied

•		
Waste Management Plan	Preferred Format:	
The relevant form from the Development Control Code for 
Best Practice Waste Management in the ACT	

Note:	

These forms are available from the Planning and Land Authority or from the ACT NOWaste website at www.nowaste.act.gov.au 

	

Not applicable

Supplied

•		
Landscape Intentions Plan	Preferred Format:	
A3 (A1 for large or complex proposals) black & white	

Preferred Scales:	
1:200	

Minimum Content:	
•	Existing and proposed contours
•	Retaining structures boundary treatments including courtyard walls and fences
•	Surface treatments showing pervious and impervious surfaces
•	Surface storm water management including drainage and taps
•	Areas to be irrigated including type of system	

Not applicable

Supplied

•		

Submission Requirement
	Required information	Applicant Use	Office Use	
Landscape Plan
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:200	

Minimum Content:	
•	Trees on the site proposed to be retained
•	Proposed landscaping
•	Schedule of plants including species, and the number of plants to be planted
•	Tree protection zones for all protected trees affecting the site, accurately shown (including tree protection zones of trees on adjacent or adjoining blocks)
•	For proposals in heritage areas and redevelopment in established areas an evaluation of all existing trees to be provided.
•	Existing and proposed contours
•	Retaining structures boundary treatments including courtyard walls and fences
•	Surface treatments showing pervious and impervious surfaces
•	Surface storm water management including drainage and taps
•	Areas to be irrigated including type of system	

Not applicable

Supplied

•		
Landscape Management and Protection Plan
	Preferred Format:	
A3 black and white	

Preferred Scales:	
1:200	

Minimum Content:	
•	Location and species of existing trees in the verge areas, including height, girth, drip area and condition
•	The method proposed to allow through pedestrian access to continue within the verge during construction on the site
•	Tree protection measures, including fencing proposed to protect verge areas from access and damage during construction
•	Location of driveway across verge and existing services such as grates, hydrants, road signs, bus stops, footpaths, etc.
•	References to verge above will also apply to other surrounding Territory Land (such as laneways, parks, open space) that may be affected by the development	

Not applicable

Supplied

•		
Utilities Diagram
	Preferred Format:	
A4, A3 - black and white	

Preferred Scales:	
1:200, 1:500	

Endorsed by:	
ACTEWAGL	

Description:	
•	On request, ActewAGL will furnish a utilities diagram for the development site showing the approximate location of ActewAGL assets including sewers, electricity lines and associated installations, water pipes and gas pipes. Its principle role is to alert the applicant to potential conflicts with existing utilities

	

Not applicable

Supplied

•		
Erosion & Sediment Control Plan
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Minimum Content:	
•	Prepared in accordance with Department of Territory and Municipal Services Erosion and Sediment Control Guidelines

	

Not applicable

Supplied

•		
Spoil Management Plan
	Preferred Format:	
A4 portrait, black and white	

Required When:	
Excavated material is proposed to be removed from the site (e.g. excavations of a basement or a swimming pool)	

Minimum Content:	
•	Estimated quantity of excavated material to be removed from the site
•	Description of the type of excavated material to be removed
•	Disposal site (or list of possible disposal sites)
•	Proposed method of cartage
•	Proposed hours of cartage (e.g. truck movements restricted to the hours of 8am to 6pm on weekdays)	

Not applicable

Supplied

•		

Submission Requirement
	Required information	Applicant Use	Office Use	
Tree Management Plan
	Preferred Format:	
A4, black and white	

Preferred Scales:	
1:200	

Prepared by:	
A suitably qualified person	

Description:	
•	Prepared in accordance with Department of Territory and Municipal Services Guidelines for Preparing a Tree Management Plan

Each development site that contains a protected tree will require a Tree Management Plan (TMP) to be submitted with the DA.  Protected trees can also be on the neighbouring blocks and public land and must be included as part of the Tree Management Plan (TMP) where any part of the tree protection zone falls across the development site.

	
Not applicable

Supplied

•		
Shadow Diagram(s)
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:100	

Minimum content	
•	Existing contours (as per site plan)
•	Natural & finished ground levels related to Australian Height Datum
•	The location of proposed buildings and structures
•	Shadows cast by proposed buildings, retained buildings, existing fences and proposed fences at 9am, noon and 3pm on 21 June (Winter solstice)
•	The location of all buildings and private open space on adjoining or adjacent blocks that are affected by those shadows
•	Elevations of buildings on adjoining or adjacent blocks that contain windows to habitable rooms affected by shadows cast. Where possible the type of habitable room affected should be indicated (e.g. bedroom, dining room)

	
Not applicable

Supplied

•		
Access and Mobility Report
	Preferred Format:	
A4, A3, black & white	

Preferred Scales:	
1:100	

Prepared by:	
A suitably qualified person	

Minimum content:	
This report shall contain -
•	An assessment of how the proposal complies with ACT Planning Guidelines for Access and Mobility, and provide reasons for any departures 
•	Adapted floor plan for the nominated adaptable dwellings

	
Not applicable

Supplied

•		
Composite Streetscape Elevation
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:200	

Prepared by:	
A suitably qualified person	

Required for:	
Multi-Unit housing (other than Dual Occupancy), Commercial, Industrial and Institutional developments	

Minimum content:	
•	Elevation plan to include elevations of adjoining properties to the extent necessary to illustrate the relationship of the proposal to the existing streetscape.

	

Not applicable

Supplied

•		
Offsite Works
	Preferred Format:	
A3 (A1 for large or complex proposals) black and white	

Preferred Scales:	
1:200	

Required for:	
For proposals that include works outside the lease boundary.	

Minimum content:	
•	Location and identification of any proposed works including infrastructure and landscaping, which is to include construction details sufficient to obtain Design Acceptance

	

Not applicable

Supplied

•		
On-Site Storm water Retention/
Re-Use Management Plan
	Preferred Format:	
A4, black and white	

Prepared By:	
Suitably qualified person	

Minimum Content:	
•	Plan is to show how the rate of storm water discharge from the site is to be maintained at levels no greater than the current rate of storm water discharge, or to a higher rate acceptable to the Territory
•	Plan is to show how the roof water/hard surface run off is to be re-used on the site and within the development	

Not applicable

Supplied

•		

Submission Requirement
	Required information	Applicant Use	Office Use	
Spoil Management Plan
	Preferred Format:	
A4,  portrait, black and white	

Required when:	
Excavated material is proposed to be removed from the site 
(e.g. excavations of a basement or a swimming pool)	

Minimum Content:	
•	Estimated quantity of excavated material to be removed from the site
•	Description of the type of excavated material to be removed
•	Disposal site (or list of possible disposal sites)
•	Proposed method of cartage
•	Proposed hours of cartage (e.g. truck movements restricted to the hours of 8am to 6pm on weekdays)

	
Not applicable

Supplied

•		
Noise Management Plan	Preferred Format:	
A4 black and white	

Required for:	
Proposals that include, club, drink establishment, hotel industry (except light industry), indoor recreational facility or restaurant	

Prepared by: 	
Accredited acoustic specialist	

Minimum Content:	
•	Address ways of minimizing the impact of noise on neighbours

	

Not applicable

Supplied

•		
List of Interested Parties
	Preferred Format:	
A4 black and white	

Minimum Content:	
•	List of names and addresses of all persons having a registered estate or interest (e.g. mortgagees, sub lessees) in the property

	

Not applicable

Supplied

•		
Valuation Certificate 
(will be made available on Public Register)
	Preferred Format:	
A4 portrait, black and white	

Required for:	
Proposals for a variation to a Crown lease	

Prepared by:	
An accredited valuer	

Minimum Content:	
•	A summary of the related valuation report giving V1 and V2 values

	

Not applicable

Supplied

•		
Valuation Report
	Preferred Format:	
A4 portrait, black and white	

Required for:	
Proposals for a variation to a Crown lease	

Prepared by:	
An accredited valuer	

Minimum Content:	
•	Clear details of any valuation of lease sought and a full assessment of V1 and V2 values under the relevant sections of the Planning and Development Act 2007
•	Where a variation relates to an amendment of a provision in a lease and either a consolidation or subdivision, two full assessments of V1 and V2 values must be provided quoting the relevant section of the Planning and Development Act 2007 in each case

Valuation assessments must include all relevant information utilised in the valuation assessment and full disclosure of all matters that may affect the assessment, market evidence, supporting valuation rationale and market commentary (as considered necessary by the ACT Planning and Land Authority), professionally drawn plans, specifications and associated costings. (The accuracy of costing may need to be verified by a relevant professional)	

Not applicable

Supplied

•		

VALUATION REPORT NOTES:

1.	The ACT Planning and Land Authority may refuse to accept the valuation assessment if insufficient details, evidence or other required valuation material to allow proper assessment of V1 and V2 values have not been provided, or if API Professional Practice Standards have not been adhered to.

2.	The ACT Planning and Land Authority may also request clearer definition or further valuation evidence, rationale, costings or other information, if it is considered necessary to properly determine a change of use charge.

3.	Should conditions of approval or any other matters materially affect the original assessment, the ACT Planning and Land Authority may require the valuation to be resubmitted after the relevant valuer is advised of any new or changed conditions or circumstances.

Guidelines for Valuation Reports

Valuation reports are to be full speaking valuations presented under the following headings:

HEADING	
DESCRIPTION	

1.	Date of Inspection	

2.	Date of lease variation approval	

3.	Date of valuation	

4.	Details of current Crown lease 	
Commencement date, lease term, rental, lease purpose, gross floor area, car parking requirements and site area

5.	Town planning	
Current land use policy

6.	Proposed lease variation	
Details of proposed changes to the purpose clause, details of proposed additional development rights

7.	Statutory valuations - 	
Current average unimproved value for rating	

8.	Services and amenities	

9.	Location and access	

10.	Property description - 	
Land, structures, car parking

11.	Tenancies - 	
Current tenancy schedule	

12.	Contamination	

13.	Valuation basis	

14.	Reference to the appropriate section in the Planning & Development Act 2007	

15.	Valuation approach V1 and V2 	
Methodology, most appropriate method direct comparison capitalization of income hypothetical development, brief market commentary, sales evidence, rental evidence, outgoings, reconciliation, capitalisation rate evidence of market yields, cost of works as condition of variation Valuations - calculations V1and V2

	

Entity Advice 
•	Must be provided where required for Code track DAs or DA must be refused
•	May be provded with Merit and Impact track DAs
If Entity advice not provided with DA you must provide the necessary infromation iwith your application so your proposal can be referred to the relevant entity 	Applicant Use	Office Use	
DEMOLITION	Statement of Endorsements from Utilities Providers	•	Provided
•	Not provided
•	Not required	

	
HERITAGE	Heritage Council Advice	•	Provided
•	Not provided
•	Not required	

	
TREES	Approved Tree Management Plan	•	Provided
•	Not provided
•	Not required	

	
HAZARDOUS MATERIALS	Hazardous Material Survey endorsed by Environment Protection Authority	•	Provided
•	Not provided
•	Not required	

	
CONTAMINATION	Statement of Endorsement from relevant entity.	•	Provided
•	Not provided
•	Not required	

	
EROSION & SEDIMENT CONTROL	Plan endorsed by Environment Protection Authority	•	Provided
•	Not provided
•	Not required	

	
NOISE	Noise Management Plan that has been endorsed by Environment Protection Authority	•	Provided
•	Not provided
•	Not required	

	
WASTE MANAGEMENT FOR WASTE FACILITIES & MANAGEMENT
	Statement of Compliance for Waste Facilities and Management	•	Provided
•	Not provided
•	Not required	

	
SERVICING AND SITE MANAGEMENT	Statement of Endorsement from relevant entities	•	Provided
•	Not provided
•	Not required	

	
UTILITIES	Statement of Compliance from each of the relevant utilities providers	•	Provided
•	Not provided
•	Not required	

	
			
Other Information Requirements (Non Referral Matters)	Applicant Use	Office Use	
LOCATION REQUIREMENTS	Evidence provided in statement against the relevant criteria demonstrates the development meets the requirements of the Community and Recreation Facilities Location General Code	•	Provided
•	Not provided
•	Not required	

	
PLANS OF MANAGEMENT
	Evidence provided in statement against the relevant criteria demonstrating consistency with all relevant Plans of Management	•	Provided
•	Not provided
•	Not required	

	
SUBDIVISION	Evidence provided in statement against the relevant criteria demonstrating subdivision development code requirements have been met	•	Provided
•	Not provided
•	Not required	

	
NATIONAL CAPITAL PLAN	Evidence provided in statement against the relevant criteria demonstrating National Capital Plan requirements have been met	•	Provided
•	Not provided
•	Not required	

	
CRIME PREVENTION TROUGH ENVIRONMENTAL DESIGN
	Evidence provided in statement against the relevant criteria demonstrating CPTED general code requirements have been met	•	Provided
•	Not provided
•	Not required	

	
ACCESS AND MOBILITY	Evidence provided in Statement against the relevant criteria that Access and Mobility code requirements have been met	•	Provided
•	Not provided
•	Not required	

	

Other Information Requirements (Non Referral Matters)	Applicant Use	Office Use	
TRAFFIC GENERATION	Evidence provided in statement against the relevant criteria demonstrating traffic generation  requirements have been met
	•	Provided
•	Not provided
•	Not required	

	
SITE ACCESS	Evidence provided in statement against the relevant criteria demonstrating site access complies with the requirements of the Parking and Vehicular Access General Code
	•	Provided
•	Not provided
•	Not required	

	
PARKING (CAR)	Evidence provided in statement against the relevant criteria demonstrating Parking and Vehicular Access general code requirements have been met
	•	Provided
•	Not provided
•	Not required	

	
PARKING (BICYCLE)	Evidence provided in statement against the relevant criteria demonstrating Bicycle Parking  general code requirements have been met
	•	Provided
•	Not provided
•	Not required	

	
LANDSCAPE	Evidence provided in statement against the relevant criteria demonstrating landscape design concepts address all of the requirements contained in the Development Code 
	•	Provided
•	Not provided
•	Not required	

	
SIGNS	Evidence provided in statement against the relevant criteria demonstrating Signs general code requirements have been met
	•	Provided
•	Not provided
•	Not required	

	
LIGHTING	Evidence provided in statement against the relevant criteria demonstrating external lighting provided to building frontages, to all pathways, roads, laneways, and car parking areas is in accordance with Australian Standard AS 1158.1.3 Pedestrian Lighting
	•	Provided
•	Not provided
•	Not required	

	
NEIGHBOURHOOD PLANS	Evidence provided in statement against the relevant criteria demonstrating Neighbourhood Plan requirements have been met
	•	Provided
•	Not provided
•	Not required	

	
ASSESSMENT OF ENVIRONMENTAL EFFECTS	Evidence provided in statement against the relevant criteria demonstrating the development achieves a minimum 40% reduction in mains water consumption?
	•	Provided
•	Not provided
•	Not required	

	
WATER SENSITIVE URBAN DESIGN (MAINS WATER CONSUMTION)
	Evidence provided in statement against the relevant criteria demonstrating mains water consumption requirements have been met
	•	Provided
•	Not provided
•	Not required	

	
WATER SENSITIVE URBAN DESIGN (STORMWATER QUALITY)
	Evidence provided in statement against the relevant criteria demonstrating stormwater requirements have been met	•	Provided
•	Not provided
•	Not required	

	
WATER SENSITIVE URBAN DESIGN (STORMWATER QUANTITY)
	Evidence provided in statement against the relevant criteria demonstrating stormwater requirements have been met	•	Provided
•	Not provided
•	Not required	

	

Other Information Requirements (Non Referral Matters)	Applicant Use	Office Use	
WATER USE	Evidence provided in statement against the relevant criteria demonstrating compliance with the Water Use and Catchment General Code	•	Provided
•	Not provided
•	Not required	

	
BUSHFIRE RISK MANAGEMENT	Evidence provided in statement against the relevant criteria demonstrating the development complies with the Planning for Bushfire Risk Mitigation General Code	•	Provided
•	Not provided
•	Not required	

	

				
Other Information Requirements 	Applicant Use	Office Use	
ENVIRONMENTAL IMPACT STATEMENT	Prepared and completed in accordance with the requirements of the Planning and Development Act 2007
IMPACT ASSESSMENT TRACK ONLY
	•	Provided
•	Not provided
•	Not required	

	

Applicant Name: 		
Signature:		

Technical Officer Name:		
Date::