BA200817 - 35 Oriole Ave PEREGIAN BEACH - 200817 - DA Form 1 · OPW20/0154

PART 9 – FOR COMPLETION OF THE ASSESSMENT MANAGER – FOR OFFICE
USE ONLY

 Date received:                                   Reference number(s):

 Notification of engagement of alternative assessment manager
 Prescribed assessment manager                                   John Dunn
 Name of chosen assessment manager                               John Dunn
 Date chosen assessment manager engaged                          11/09/2020
 Contact number of chosen assessment manager                     1300 596 371
 Relevant licence number(s) of chosen assessment                 A621704
 manager

 QLeave notification and payment
 Note: For completion by assessment manager if applicable
 Description of the work                                         New Drive Way Cross Over
 QLeave project number                                           Not Applicable
 Amount paid ($)                                                 Date paid (dd/mm/yy)
 Date receipted form sighted by assessment manager
 Name of officer who sighted the form                            John Dunn




                                                                                                                          Page 12
                                                                                        DA Form 1 – Development application details
                                                                                                     Version 1.2— 7 February 2020