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

20…………………..	

Lease/Site Details Please Print

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

Block	

Section	
	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

Lessee (Property Owners) Details Please Print

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

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	

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

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	

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.

Notice of Decision 

Your notice of decision will be returned via email please ensure you provide an email address.

Fully Describe Your Proposal 
Example: Vary the lease to specify the maximum number of dwellings permitted; or alter/amend the easements in the Crown lease; or delete the easements in the Crown lease

	

Use of the Land 

Describe the proposed use of the land or the proposed use of a building or structure on the land.
Example: Residential purposes for a single dwelling

Assessment Track, Zone, Development/Precinct Code

Please indicate which assessment track applies to this development application

•	CODE					

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/s applies to this application:	

Conflict of Interest Declaration

Does the applicant or lessee have any association with ESDD 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.

Exclusion from Public Inspection

In accordance with the requirements of Sections 28 and 30 of the Planning and Development Act 2007 the 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	•	NO	•	YES	
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

Exclusion from Public Inspection continued

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.

Other Development Application Requirements

RELEVANT ENTITY ADVICE

If entity endorsement is required by the code it MUST be provided at the time the application is lodged as a supporting document.

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.

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

If the DA documentation is not acceptable for lodgement, 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.

DOCUMENTATION AND PLANS

All required documentation must be provided in an electronic format and meet the following requirements 

•	Each document must be saved as a PDF and named in accordance with the naming convention as detailed on the ESDD website. 
•	All plans must be to scale.
•	All plans must be rotated to the correct orientation i.e. they are the right way up when opened
•	All plans are to be clear and concise and generally consistent with Australian Standard 1100.301 - 1985 and Australian Standard 1100.301 supplementary - as updated from time to time.

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 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 Planning and Land Authority;

I /we understand that this application will be considered lodged once the relevant application fees have been paid;

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 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;

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 Planning and Land Authority will not provide written advice of this decision.  I/we also understand that the 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 Planning and Land Authority its servants and agents to erect sign/s on the subject property(s) as required and 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 or in the attached letter of appointment 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 Planning and Land Authority when required, alter, amend or provide further information as necessary and receive any communications relating to this Development Application;

I/we declare that information relating to utility standards, access provisions and asset clearance zones has been sought from the relevant utility providers and this development application has been prepared in accordance with their requirements;

I understand that costs associated with 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 the relocation of these services;

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 Custodian Signature 
(unleased land only)	

	Date		
				
Delegate of the Planning & Land Authority 
(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, the Australian Valuation 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. 
Contact Details:
Environment, Planning and Sustainable Development Directorate
Customer Service Centre
GPO Box 158, Canberra City 2601
16 Challis Street, Dickson ACT 2602
Business Hours: 8.30am to 4.30pm weekdays (excluding Public Holidays)
Phone: (02) 6207 1923
Email: epdcustomerservices@act.gov.au	Website: www.planning.act.gov.au