01.5 - Da Form 1 · 132007.616.05

  

 

Matters requiring referral to the Queensland Fire and Emergency Service:

| 0 Tidal works, or development in a coastal management district

 

   
   

18) Has any referral agency provided a referral response for this development application?

| O Yes — referral response(s) received and listed below are attached to this development application
| O No
| Referral requirement | Referral agency | Date of referral response

 

 

|

|

| = — |

| Identify and describe any changes made to the proposed development application that was the subject of the referral |
| response and the development application the subject of this form, or include details in a schedule to this development |

application (if applicable) |

PART 6 — INFORMATION REQUEST

 

19) Information request under Part 3 of the DA Rules
| O | agree to receive an information request if determined necessary for this development application
| 1 | do not agree to accept an information request for this development application |
| Note: By not agreeing to accept an information request |, the applicant, acknowledge:

| « that this development application will be assessed and decided based on the information provided when making this development application and |
| the assessment manager and any referral agencies relevant to the development application are not obligated under the DA Rules to accept any |
additional information provided by the applicant for the development application unless agreed to by the relevant parties |

|

| © Part 3 of the DA Rules wil still apply if the application is an application listed under section 11.3 of the DA Rules
Further advice about information requests is contained in the DA Forms Guide.

PART 7 — FURTHER DETAILS

20) Are there any associated development applications or current approvals? (e.g. a preliminary approval)

    

O Yes — provide details below or include details in a schedule to this development application
| O No

| List of approval/development | Reference number | Date | Assessment manager
| application references | |

pees
| O Approval
| Development application —_|
| 1 Approval |
| 1 Development application

 

 

 

|

es _ = 4
|
|

a ee

 

1 Yes — the yellow local government/private certifier’s copy of the receipted QLeave form is attached to this development
application

O No~I, the applicant will provide evidence that the portable long service leave levy has been paid before the assessment
manager decides the development application. | acknowledge that the assessment manager may give a development approval
only if | provide evidence that the portable long service leave levy has been paid

| C1 Not applicable

 

 

| Amount paid | Date paid (dd/mm/yy) | Qleave levy number (A, B or E) |
|$ | | |