This document must be provided for the following types of development applications in all areas except for the City, Town Centres or Industrial Zone as defined by Schedule 3 Planning and Development Regulations 2008:

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

Lease/Site Details Please Print

If more than one lease/site, attach the following details for each lease/site

Block/s	
		Section			Suburb		
		
District	

Street Address	

Description of Development Proposal

COMMUNITY CONSULTATION SUMMARY

I/we hereby certify that the following community consultation was undertaken prior to the lodgement of the development application:

Please tick relevant boxes
•	LETTER BOX DROP

o	Delivery Date/s:      _______________________________

o	Suburb/s Covered: _______________________________
	•	COMMUNITY MEETING

o	Date & Time:      _______________________________

o	Location:             ______________________________
	
•	MEETING WITH COMMUNITY COUNCIL

o	Date & Time:          ________________________________

o	Location:               ________________________________
	•	OTHER – Please specify

   _______________________________________________

   _______________________________________________
 	
*Failure to consult with the community prior to lodgement may result in 
delays processing your development application.

Applicant Details Please Print

Applicants Name	

Applicant Signature	
	Date