This document must be provided for the following types of development applications in all areas except for Industrial Zones as defined by the Territory Plan or in an area outlined in Schedule 1B of the Planning and Development Regulations 2008:
o	a residential building intended to be higher than 3 storeys and consisting of more than 15 units
o	a building where the total floor space of which is intended to be more than 5000m2
o	a building or structure intended to be higher than 25m above finished ground level
o	a variation of a lease to remove its concessional status

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

Delivery Date/s:      _______________________________

Suburb/s Covered: _______________________________
	•	COMMUNITY MEETING

Date & Time:     __________________________________

Location:           __________________________________
	
•	MEETING WITH COMMUNITY COUNCIL

Date & Time:          ________________________________

Location:               _________________________________
	•	OTHER – Please specify

   _______________________________________________

   _______________________________________________
 	
*Pre-DA community consultation must be undertaken for prescribed development.  The proposal, that is the subject of the consultation, must be substantially the same as the proposal in the development application.

Applicant Details Please Print

Applicants Name	

Applicant Signature	
	Date