Development Application Part 1 of 2 - IDAS Forms 1 and 6 - OPW13/0309

12. Is the payment of a portable long service leave levy applicable to this application? (Referto 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.)

[gJ   No


o     Yes-complete Table N and submit with this application the yellow local government/private certifier’s copy of the
      receipted QLeave form

Table N

Amount paid             Date paid           QLeave project number (6digit number starting with A, B, 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 Has the local government agreed to apply a superseded planning scheme to this application under section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 20091


[gJ   No


o     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 fonns and supporting infonnation that accompany this application (Include all IDAS
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


(1)Plans & specifications relevant to the proposed works,                                            Email for printing if required.


(2)IDAS Form 6                                                                                       Email for printing if required.




16. ~pplicant’s decla~tlon                                      ~ b",                     ~
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                                                                                                                                 ,’!Ol,);’   ,
                                                                             ~   [I   w       ’.Ii




[gJ By 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-App/cation details
                                                                                                             Version 2,017 December 2012