10/0662 - Operational Works [As Published] · 142010.662

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QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)

1
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Description of the work

QLeave Project
Number

Amount
paid ($)

Date paid

Date receipted
form sighted by |Name of officer who
assessment _ |sighted the form

manager

 

 

 

 

 

 

 

 

 

 

The Sustainable Planning Act 2009 (SPA) is administered by the Department of Infrastructure and Planning. This
form and all other required application materials should be sent to your assessment manager and any referral

agencies.

 

_ eee 4

 

Application Details - IDAS form 7
Version 1.0 18 December 2009 i