Development Application part 1 of 2 IDAS Forms MCU13/0030

12. Is the payment of a portable long service leave levy applicable to this application? (Refer to notes at the end
of this form for more information.)


[gJ   No-go to question 14            DYes

13. Has the portable long service leave levy been paid? (Referto notes at the end of this form for more
information.)

D     No


D     Yes-complete Table N and submit with this application the yellow local governmenUprivate certifier’s copy of the
      receipted QLeave form

Table N

Amount paid             Date paid           QLeave project number (6digit number starting with A, 8, E, L or P)

                        (dd/mm/yy)




14. Has the local government agreed to apply a superseded planning scheme to this application under section
96 of the Sustainable Planning Act 2oo9?


[gJ   No


D     Yes-please provide details below


Name of local government                          Date of written notice given      Reference number of written notice given
                                                  by local government               by local government (if applicable)
                                                  (dd/mm/yy)




15. List below all of the forms and supporting information that accompany this application (Include alllDAS
forms, checklists, mandatory supporting information etc. that will be submitted as part of this application. Note: this
question does not apply for applications made online using Smart eOA.)

Description of attachment or title of attachment                                              Method of lodgement to
                                                                                              assessment manager


IDAS Form 5                                                                                   Over the counter

KHA Cover Letter                                                                              Over the counter

Town Planning Report and Attachments                                                          Over the counter

Landowners Consent Form                                                                       Over the counter




 16. Applicant’s declaration


[gJ 8y making this application, I declare that all information in this application is true and correct (Note:it is unlawful to
provide false or misleading information.)




6                                                                                                  IDAS form 1-Application details
                                                                                                     Version 2 0 17 December 2012