01.5 - Da Form 1 · 132007.616.05

PART 9 — FOR OFFICE USE ONLY

 

SSS a ey

Date received: | Reference number(s):

Notification of engagement of alternative assessment manager.

Prescribed assessment manager |

 

 

 

| Name of chosen assessment manager | |

 

| Date chosen assessment manager engaged
Contact number of chosen assessment manager |

| Relevant licence number(s) of chosen assessment
manager |

QLeave notification and payment
Note: For completion by assessment manager if applicable

| Description of the work

 

 

| QLeave project number | - - / |
 AMOUNEDEIA See
Date paid

 

 

 

 

 

Date receipted form sighted by assessment manager

 

Name of officer who sighted the form

 

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and all other required development application materials should
be sent to the assessment manager.

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DA Form 1 — Development Application details