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Prop No Developer Contribution Levy Payment Advice Form Baw Baw Shire Council PO Box 304 Warragul Ph 5624 2411 Fax 56222287 Instructions Complete Your Details and send to Baw Baw Shire Council to receive advice in respect to Planning Scheme requirements of the required amount for the Developer Contribution Levy at an address. Your Contact Details Name Postal Address Telephone Number Preferred Response Email to Fax Letter The Subject Land Address Title Details/Property Description attach copy of title Owner Proposed works for this application eg. Dwelling subdivision-number of lots Planning Permit No* if applicable ---------------------------------------------- OFFICE USE ONLY -----------------------------------------------Is a developer contribution levy payable Yes No If yes Amount Payable is. Amount payable only valid until 30 June 2012 If a developer contribution levy is payable has it been paid If yes Receipt Number Date Council Certification that Levy has been paid in full Date of Advice Planning Officer Note Council cannot guarantee that all outstanding Developer Contribution Levy amounts have been paid until this form has been signed and dated by a Baw Baw Shire Council Planning Department Officer. Your Contact Details Name Postal Address Telephone Number Preferred Response Email to Fax Letter The Subject Land Address Title Details/Property Description attach copy of title Owner Proposed works for this application eg. Dwelling subdivision-number of lots Planning Permit No* if applicable ---------------------------------------------- OFFICE USE ONLY -----------------------------------------------Is a developer contribution levy payable Yes No If yes Amount Payable is. Dwelling subdivision-number of lots Planning Permit No* if applicable ---------------------------------------------- OFFICE USE ONLY -----------------------------------------------Is a developer contribution levy payable Yes No If yes Amount Payable is. Amount payable only valid until 30 June 2012 If a developer contribution levy is payable has it been paid If yes Receipt Number Date Council Certification that Levy has been paid in full Date of Advice Planning Officer Note Council cannot guarantee that all outstanding Developer Contribution Levy amounts have been paid until this form has been signed and dated by a Baw Baw Shire Council Planning Department Officer. Your Contact Details Name Postal Address Telephone Number Preferred Response Email to Fax Letter The Subject Land Address Title Details/Property Description attach copy of title Owner Proposed works for this application eg. Dwelling subdivision-number of lots Planning Permit No* if applicable ---------------------------------------------- OFFICE USE ONLY -----------------------------------------------Is a developer contribution levy payable Yes No If yes Amount Payable is. Amount payable only valid until 30 June 2012 If a developer contribution levy is payable has it been paid If yes Receipt Number Date Council Certification that Levy has been paid in full Date of Advice Planning Officer Note Council cannot guarantee that all outstanding Developer Contribution Levy amounts have been paid until this form has been signed and dated by a Baw Baw Shire Council Planning Department Officer.

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