DA Form 2

Unit No.            Street No.          Street Name and Type                                Suburb
                    320                 Black Mountain Road                                 BLACK MOUNTAIN
Postcode            Lot No.             Plan Type and Number (e.g. RP, SP)                  Local Government Area(s)
4563                2                   RP 179073                                           Noosa Council
2.2) Additional premises
☐ Additional premises are relevant to this development application and the details of these premises have been
    attached in a schedule to this development application
☒ Not required

3) Are there any existing easements over the premises?
Note: Easement uses vary throughout Queensland and are to be identified correctly and accurately. For further information on easements and how
they may affect the proposed development, see the DA Forms Guide

☐ Yes – All easement locations, types and dimensions are included in plans submitted with this development
           application
☒ No

PART 3 – FURTHER DETAILS
4) Is the application only for building work assessable against the building assessment provisions?
☐ Yes – (proceed to 8)
☒ No
5) Identify the assessment manager(s) who will be assessing this development application
Noosa Council

6) Has the local government agreed to apply a superseded planning scheme for this development application?
☐ Yes – a copy of the decision notice is attached to this development application
☐ The local government is taken to have agreed to the superseded planning scheme request – relevant documents
    attached
☒ No
7) Information request under Part 3 of the DA Rules
☒ I agree to receive an information request if determined necessary for this development application
☐ I do not agree to accept an information request for this development application
Note: By not agreeing to accept an information request I, the applicant, acknowledge:
·    that this development application will be assessed and decided based on the information provided when making this development application
    and the assessment manager and any referral agencies relevant to the development application are not obligated under the DA Rules to accept
    any additional information provided by the applicant for the development application unless agreed to by the relevant parties.
·   Part 3 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules.
Further advice about information requests is contained in the DA Forms Guide.

8) Are there any associated development applications or current approvals?
☐ Yes – provide details below or include details in a schedule to this development application
☒ No
List of approval/development             Reference                             Date                                 Assessment manager
application
☐ Approval
☐ Development application
☐ Approval
☐ Development application

9) Has the portable long service leave levy been paid?
☒ Yes – a copy of the receipted QLeave form is attached to this development application
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                                                                                                    DA Form 2 – Development Application details
                                                                                                                Version 1.2 — 7 February 2020