Application Form

PART 8 — CHECKLIST AND APPLICANT DECLARATION

24) Development application checklist

 

| 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 to6 of DAForm2- [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 14) 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 LC Yes
development permit is issued (see 21)) EX Not applicable

 

25) Applicant declaration

 

XI By making this development application, | declare that all information in this development application is true and

correct

(? Where an email address is provided in Part 1 of this form, | 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:

e 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

e required by other legislation (including the Right to Information Act 2009); or

e 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: [oo | Reference number(s): [
Notification of engagement of alternative assessment manager

Prescribed assessment manager

 

Eat

 

Name of chosen assessment manager

 

Date chosen assessment manager engaged

 

 

 

 

Contact number of chosen assessment manager

 

Page 11
DA Form 1 — Development Application details
Version 1.1— 22 JUNE 2018