This document must be attached to a consultation report 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:

A development proposal for 1 or more of the following:
(a) 	a building for residential use with 3 or more storeys and 15 or more dwellings
(b) 	a building with a gross floor area of more than 5000m²
(c) if the development proposal is for more than 1 building – the buildings have a total gross floor area of more than 7000m2
(c) 	a building or structure more than 25m above finished ground level
(d) 	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 Please Print

COMMUNITY CONSULTATION SUMMARY

I/we hereby certify that: 
•	community consultation was undertaken prior to the lodgement of the development application in accordance with the guidelines for pre DA community consultation for prescribed developments 
•	the proposal was notified on the ACT Government’s website for pre DA community consultation prior to consultation beginning and for the entire consultation period. 

Applicant Details Please Print

Applicants Name	

Applicant Signature	
	Date