DA Form 1

        Tidal work or development within a coastal management district
        23.12) Does this development application involve tidal work or development in a coastal management district?
            Yes – the following is included with this development application:
                  Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required
                    if application involves prescribed tidal work)
                   A certificate of title
            No
        Note: See guidance materials at www.desi.qld.gov.au for further information.
        Queensland and local heritage places
        23.13) Does this development application propose development on or adjoining a place entered in the Queensland
        heritage register or on a place entered in a local government’s Local Heritage Register?
            Yes – details of the heritage place are provided in the table below
            No
        Note: See guidance materials at www.desi.qld.gov.au for information requirements regarding development of Queensland heritage places.
        For a heritage place that has cultural heritage significance as a local heritage place and a Queensland heritage place, provisions are in place
        under the Planning Act 2016 that limit a local categorising instrument from including an assessment benchmark about the effect or impact of,
        development on the stated cultural heritage significance of that place. See guidance materials at www.planning.statedevelopment.qldgov.au for
        information regarding assessment of Queensland heritage places.

        Name of the heritage place:                                                Place ID:
        Decision under section 62 of the Transport Infrastructure Act 1994
        23.14) Does this development application involve new or changed access to a state-controlled road?
           Yes – this application will be taken to be an application for a decision under section 62 of the Transport
           Infrastructure Act 1994 (subject to the conditions in section 75 of the Transport Infrastructure Act 1994 being
           satisfied)
           No
        Walkable neighbourhoods assessment benchmarks under Schedule 12A of the Planning Regulation
        23.15) Does this development application involve reconfiguring a lot into 2 or more lots in certain residential zones
        (except rural residential zones), where at least one road is created or extended?
           Yes – Schedule 12A is applicable to the development application and the assessment benchmarks contained in
        schedule 12A have been considered
           No
        Note: See guidance materials at www.planning.statedevelopment.qld.gov.au for further information.


     PART 8 – CHECKLIST AND APPLICANT DECLARATION
        24) Development application checklist
        I have identified the assessment manager in question 15 and all relevant referral
        requirement(s) in question 17                                                                                           Yes
        Note: See the Planning Regulation 2017 for referral requirements
        If building work is associated with the proposed development, Parts 4 to 6 of DA Form 2 –                               Yes
        Building work details have been completed and attached to this development application                                  Not applicable
        Supporting information addressing any applicable assessment benchmarks is with the
        development application
        Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report          Yes
        and any technical reports required by the relevant categorising instruments (e.g. local government planning
        schemes, State Planning Policy, State Development Assessment Provisions). For further information, see DA
        Forms Guide: Planning Report Template.
        Relevant plans of the development are attached to this development application
        Note: Relevant plans are required to be submitted for all aspects of this development application. For further          Yes
        information, see DA Forms Guide: Relevant plans.
        The portable long service leave levy for QLeave has been paid, or will be paid before a                                 Yes
        development permit is issued (see 21)                                                                                   Not applicable




Document Set ID: 23371843
Version: 1, Version Date: 26/11/2024