Operational Works Application OPW21/0177 - Revised DA Form 1 & Photos attached - 5 Oceanmist Ct, Noosaville

     24) Development application checklist
     I have identified the assessment manager in question 15 and all relevant referral
     requirement(s) in question 17
     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
     development application
     Note This is a mandatory requirement and includes any relevant templates under question 23, a planning report
     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                                              s
     Note: Relevant plans are required to be submitted for all aspects of this development application. For further       v. 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                              I] Yes
     development permit is issued {see 21))                                                                               i/Not applicable

     25) Applicant declaration
      V' By making this development application, I declare that all information in this development application is true and


k.   correct
     I v/Where an email addrecs is provided in Part 1 of this form, I consent to receive future electronic communications
     from the assessment-manager and any referral agency for the development application where written information is
     required or permitted pursuant to sections 11 and 12 of the Electronic Transactions Act 2001
     Note It is unlawful to intentionally provide false or misleading information.
     Privacy - Personal information collected in this form will be used by the assessment manager and/or chosen
     assessment manager, any relevant referral agency and/or building certifier (including any professional advisers
     which may be engaged by those entities) while processing, assessing and deciding the development application.
     All information relating to this development application may be available for inspection and purchase, and/or
     published on the assessment manager's and/or referral agency’s website.
     Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Regulation
     2017 and the DA Rules except where:
     • such disclosure is in accordance with the provisions about public access to documents contained in the Planning
          Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and
          Planning Regulation 2017; or
     • required by other legislation (including the Right to Information Act 2009); or
     • otherwise required by law
     This information may be stored in relevant databases The information collected will be retained as required by the
     Public Records Act 2002.

     PART 9 - FOR OFFICE USE ONLY

     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




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                                                                                                             DA Form 1 - Development Application details
                                                                                                                           Version 1.1— 22 JUNE 2018