Type of Application
•	Submission of Further Information as requested under Section 141 of the Planning and Development Act 2007		Insert Proposal Number to which this information relates 

20………………..	

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/Business Number (ACN/ABN)		
		
Postal Address	

Suburb	
		State			Postcode		
				
Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS	
	
Please list/fully describe the information being provided

EXAMPLE: New floor plan, shadow diagram and draft tree management plan

	

	

	

	

Applicant Declaration

I/we declare that this application is accompanied by all of the required information or documents as requested by the Planning and Land Authority in accordance with Section 141 of the Planning and Development Act 2007;

I/we understand that the documentation provided via the electronic lodgement process will be considered to be the relevant documentation associated with this application.  All development application documentation will be made available for public inspection including via the Internet unless exclusion has been approved;

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

Applicant Signature (s)	
	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.

Contact Details:
Environment and Sustainable Development Directorate
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: esddcustomerservices@act.gov.au	Website: www.environment.act.gov.au