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DA Form 1 OPW Application-2 Peppertree Cl

Attached to the e-mail Operational Works Application OPW21/0048 - 2 Peppertree Cl Marcus Beach.

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DA Form 1 — Development application details
Approved form (version 1.3 effective 28 September 2020) made under section 282 of the Planning Act 2016.

 

This form must be used to make a development application involving code assessment or impact assessment,
except when applying for development involving only building work.

For a development application involving building work only, use DA Form 2 — Building work details.

For a development application involving building work associated with any other type of assessable development
(i.e. material change of use, operational work or reconfiguring a lot), use this form (DA Form 1) and parts 4 to 6 of
DA Form 2 — Building work details.

Unless stated otherwise, all parts of this form must be completed in full and all required supporting information must
accompany the development application.

One or more additional pages may be attached as a schedule to this development application if there is insufficient
space on the form to include all the necessary information.

 

This form and any other form relevant to the development application must be used to make a development
application relating to strategic port land and Brisbane core port land under the Transport Infrastructure Act 1994,
and airport land under the Airport Assets (Restructuring and Disposal) Act 2008. For the purpose of assessing a
development application relating to strategic port land and Brisbane core port land, any reference to a planning
scheme is taken to mean a land use plan for the strategic port land, Brisbane port land use plan for Brisbane core
port land, or a land use plan for airport land.

 

 

 

Note: All terms used in this form have the meaning given under the Planning Act 2016, the Planning Regulation 2017, or the Development
Assessment Rules (DA Rules).

PART 1 —APPLICANT DETAILS

 

1) Applicant details

 

 

 

 

 

 

 

 

 

 

 

 

Applicant name(s) (individual or company full name) s AWN dh CHIAED So
Contact name (only applicable for companies)

Postal address (P.O. Box or street address) “. FEPFOL TEE CC
Suburb MALS Be4ed
State iD

Postcode 487%

Country ANS WAL iA

Contact number O408 735 GSE
Email address (non-mandatory) Sean ea Sc 4—- BAG MNeew5 . (Oi
Mobile number (non-mandatory) :
Fax number (non-mandatory)

Applicant's reference number(s) (if applicable)

 

 

 

2) Owner's consent

 

2.1) Is written consent of the owner required for this development application?

LC Yes — the written consent of the owner(s) is attached to this development application
[41 No — proceed to 3)

 

Queensland
Government

 
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Page 2

PART 2 — LOCATION DETAILS

3) Location of the premises. (complete 3.1) or 3.2), and 3.3) as applicable)
details below and attach a site plan for-any or all premises part of the.development application. For further information, see DA

3.1) Street address and lot on plan

     

 

 

 

 

 

 

 

[4 Street address AND lot on plan (ail lots must be listed), Or
(CO Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in
water but adjoining or adjacent to land e.g. jetty, pontoon. Ail lots must be listed).
Unit No. | StreetNo. | Street Name and Type Suburb
2) ZL PEPPENT WE CLOSE Mune IVS BEET
Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
45713 | 242) Myythi a Noosy
Unit No. | StreetNo. | Street Name and Type Suburb
b
) Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)

 

 

 

 

 

 

3.2). Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or.adjacent to land

e.g. channel-dredging in. Moreton Bay)
Note: Place each set of coordinates in:a separate row.

(] Coordinates of premises by longitude and latitude
Longitude(s) Latitude(s) Datum Local Government Area(s) (if applicabie)

(1 wese4
(J GbaAg4

5 Other:
(J Coordinates of premises by easting and northing
Easting(s) Northing(s) Zone Ref. | Datum Local Government Area(s) (if applicable)
[154 C1 wese4
(155 (1 Gpag4
(156 (J Other:

    

 

 

 

 

 

 

 
     

   
 
  

 

 

 

 

3.3) Additional premises

(J Additional premises are relevant to this development application and the details of these premises have been
ane in a schedule to this development application
N

lot required

 

 

4) Identify any ofthe following that apply to the premises and provide any relevant details

(J In or adjacent to a water body or watercourse or in or above an aquifer
Name of water body, watercourse or aquifer: |
(J On strategic port land under the Transport Infrastructure Act 1994
Lot on pian description of strategic port land:

Name of port authority for the lot:

(J Ina tidal area

Name of local government for the tidal area (if applicable):
Name of port authority for tidal area (if applicable):

[J On airport land under the Airport Assets (Restructuring and Disposal) Act 2008
Name of airport:

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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DA Form 1 — Development application details
Version 1.3—- 28 September 2020

Page 3

SCG Engineers
31000-C1.1


[OCR of page images]
 

(1 Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994
EMR site identification: |

(2 Listed on the Contaminated Land Register (CLR) under the Environmental Protection Act 1994

CLR site identification: |

 

 

 

 

 

 

5) Are there any existing easements over the premises?

Note: Easement uses vary throughout Queensland and.are fo be identified correctly and accurately. For further information on easements and
how they may affect:the proposed development, see DA ‘Forms Guide.

(2 Yes — All easement locations, types and dimensions are included in plans submitted with this development
application
No

PART 3 —- DEVELOPMENT DETAILS

    

Section 1 — Aspects of development
6.1) Provide details about the first development aspect

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2 Relevant plans of the proposed development are attached to the development application
6.3) Additional aspects of development

CJ Additional aspects of development are relevant to this development application and the details for these aspects
that would be required under Part 3 Section 1 of this form have been attached to this development application

(2 Not required

 

 

 

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DA Farm 1 ~ Development application details
Version 1.3— 28 September 2020

Page 4

Section 2 — Further development details

7) Does the proposed development application involve any of the following?

 

 

 

 

 

Material change of use (1 Yes — complete division 1 if assessable against a local planning instrument
Reconfiguring a lot (1 Yes — complete division 2

Operational work [Wes — complete division 3

Building work (] Yes - complete DA Form 2 - Building work details

 

 

Division 1 ~ Material change of use
Note: This division is only required to be completed if any part of the development application involves a material change of use assessable against a

local planning instrument.
8.1) Describe the proposed material change of use

Provide a general description of the Provide the planning scheme definition | Number of dwelling | Gross floor
proposed use (include each definition in a new row) units (if applicable) area (m?)
(if applicable)

     

 

 

 

 

 

 

8.2) Does the proposed use involve the use of existing buildings Oi ue
0 Yes
[I No

 

 

 

 

 

Division 2 — Reconfiguring a lot
Note: This division is only required to be completed if any part of the development application involves reconfiguring a lot.
9.1) What is the total number of existing lots making up the premises?

9.2) What is the nature of the lot reconfiguration? (tick al! applicable boxes)

    
  
  
 

 

(1) Subdivision (complete 10) (1 Dividing tand into parts by agreement (complete. 11))
(J Boundary realignment (complete 12)) CD Creating or changing an easement giving access to a lot
from a constructed road (complete 13))

 

 

 

 

  
  
   

10) Subdivision
10.1) For this development, how many lots are being created and what is the intended use of those lots:

   

Intended use of lots created Residential Commercial

 

Industrial Other, please specify:

 

 

 

Number of lots created

10,2) Will the Subdivision be staged?

(J Yes — provide additional details below
[C1 No

How many stages will the works include?

What stage(s) will this development application
apply to?

 

 

 

 

 

 

 

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DA Form 1 — Development application details
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Page 5

41) Dividing land into parts by agreement — how many parts are being created and what is the intended use of the

parts?

 

Intended use of parts created | Residential Commercial Industrial Other, please specify:

 

 

Number of parts created

 

 

 

 

 

 

 

12) Boundary realignment
12.1) What are the current and proposed areas for each lot comprising the premises?

Current lot Proposed lot
Lot on plan description Area (m?) Lot on plan description Area (m?)

 

 

 

 

 

 

 

 

 

12.2) What is the reason for the boundary realignment?

 

 

13) What are the dimensions and nature of any existing easements being changed and/or any proposed easement?
(attach schedule if there are more than two easements)

Existing or Width (m) | Length (m) | Purpose of the easement? (e.g. Identify the land/lot(s)
proposed? pedestrian access) benefitted by the easement

 

 

 

 

 

 

 

 

 

 

Division 3 — Operational work

[WRoad work (CJ Water infrastructure
( Drainage work ( Earthworks ( Sewage infrastructure
(7 Landscaping (J Signage (J Clearing vegetation
C Other — please specify:

 

14.2) Is the operational work necessary to facilitate the creation of new lots? (e.g. subdivision)
(1 Yes ~ specify number of new lots:
lo

 

 

14.3) What is the monetary value of the proposed operational work? (include GST, materials and labour)

$ 10,ceo APltox.
PART 4 —- ASSESSMENT MANAGER DETAILS

 

15) Identify the assessment manager(s) who will be assessing this development application

MAB LOWE .
16) Has the local government agreed to apply a superseded planning scheme for this development application?

(21 Yes — a copy of the decision notice is attached to this development application
(J The local government is taken to have agreed to the superseded planning scheme request ~ relevant documents

oe
No

    

 

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DA Form 1 ~ Development application details
Version 1.3—- 28 September 2020

Page 6

PART 5 — REFERRAL DETAILS

47) Does this development application include any aspects that have any referral requirements?
Note: A development application will require referral if prescribed by the Planning Regulation 2017.

[V'No, there are no referral requirements relevant to any development aspects identified in this development
application — proceed to Part 6

Matters requiring referral to the Chief Executive of the Planning Act 2016:

CJ Clearing native vegetation

(J Contaminated land (unexploded ordnance)

(J Environmentally relevant activities (ERA) (only if the ERA has not been devolved to a local government)

(1 Fisheries — aquaculture

(1 Fisheries — declared fish habitat area

(1 Fisheries — marine plants

(Fisheries ~ waterway barrier works

( Hazardous chemical facilities

(1 Heritage places — Queensland heritage place (on or near a Queensland heritage place)

(J Infrastructure-related referrals — designated premises

(J Infrastructure-related referrals — state transport infrastructure

(C1 Infrastructure-related referrals — State transport corridor and future State transport corridor

(J Infrastructure-related referrals — State-controlled transport tunnels and future state-controlled transport tunnels
(J Infrastructure-related referrals — near a state-controlled road intersection

1] Koala habitat in SEQ region — interfering with koala habitat in koala habitat areas outside koala priority areas
(1) Koala habitat in SEQ region — key resource areas

(J Ports — Brisbane core port land — near a State transport corridor or future State transport corridor
(2 Ports — Brisbane core port land — environmentally relevant activity (ERA)

(2 Ports — Brisbane core port land — tidal works or work in a coastal management district

(1 Ports — Brisbane core port land ~ hazardous chemical facility

(1 Ports — Brisbane core port land — taking or interfering with water

(J Ports - Brisbane core port land — referable dams

(1 Ports — Brisbane core port land — fisheries

(1 Ports — Land within Port of Brisbane’s port limits (below high-water mark)

(J SEQ development area

(2 SEQ regional landscape and rural production area or SEQ rural living area ~ tourist activity or sport and
recreation activity

2] SEQ regional landscape and rural production area or SEQ rural living area — community activity
(1 SEQ regional landscape and rural production area or SEQ rural living area — indoor recreation
(1) SEQ regional landscape and rural production area or SEQ rural living area — urban activity

(J SEQ regional Jandscape and rural production area or SEQ rural living area ~ combined use
(2 Tidal works or works in a coastal management district

(1 Reconfiguring a lot in a coastal management district or for a canal

(J Erosion prone area in a coastal management district

(J Urban design

(J Water-related development — taking or interfering with water

(J Water-related development — removing quarry material (from a watercourse or lake)

(1 Water-related development ~ referable dams

(1 Water-related development ~levees (category 3 levees only)

(J Wetland protection area

Matters requiring referral to the local government:

(Airport land
(J Environmentally relevant activities (ERA) (only if the ERA has been devolved to local govemment)

 

 

 

 

 

 

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DA Form 1 - Development application details
Version 1.3-— 28 September 2020

Page 7

‘(J Heritage places — Local heritage places vy *
Matters requiring referral to the Chief Executive of the distribution entity or transmission entity:
(J Infrastructure-related referrals — Electricity infrastructure

 

 

Matters requiring referral to:

« The Chief Executive of the holder of the licence, if not an individual

e The holder of the licence, if the holder of the licence is an individual

(C] Infrastructure-related referrals — Oil and gas infrastructure

Matters requiring referral to the Brisbane City Council:

(1 Ports ~ Brisbane core port land

Matters requiring referral to the Minister responsible for administering the Transport Infrastructure Act 1994:
(J Ports — Brisbane core port land (where inconsistent with the Brisbane port LUP for transport reasons)
(1 Ports ~ Strategic port land

Matters requiring referral to the relevant port operator, if applicant is not port operator:
(1 Ports — Land within Port of Brisbane’s port limits (below high-water mark)

 

 

 

 

Matters requiring referral to the Chief Executive of the relevant port authority:
(J Ports — Land within limits of another port (below high-water mark)

 

Matters requiring referral to the Gold Coast Waterways Authority:
(1 Tidal works or work in a coastal management district (in Gold Coast waters)

 

Matters requiring referral to the Queensland Fire and Emergency Service:
(JJ Tidal works or work in a coastal management district (involving a marina (more than six vessel berths)

18) Has any referral agency provided a referral response for this development application?

(1 Yes — referral response(s) received and listed below are attached to this development application

CI No

Referral requirement Referral agency Date of referral response

 

 

 

 

 

 

 

 

identify and describe any changes made to the proposed development application that was the subject of the

referral response and this development application, or include details in a schedule to this development application
{if applicable).

 

 

 

 

PART 6 — INFORMATION REQUEST

19) Information request under Part 3.0f the DA Rules.

hl agree to receive an information request if determined necessary for this development application
(1) | do not agree to accept an information request for this development application

Note: By not agreeing to accept an information request |, 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

e Part 3 of the DA Rules will still apply if the application is an application listed under section 17.3 of the DA Rules.

Further advice about information requests is contained in the DA Forms Guide.

 

 

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DA Form t — Development application details
Version 1.3— 28 September 2020

Page 8

PART 7 —-FURTHER DETAILS - :
20) Are there any associated development applications or current approvals? (e.9. a preliminary approval)

(1 Yes — provide details below or include details in a schedule to this development application
No

List of approval/development Reference number Date Assessment
application references manager

(Approval
(J Development application

(2 Approval
(J Development application

   
  

 

 

 

 

 

 

 

21) Has the portable long service leave levy been paid? (only. applicable to development applications involving building work or

 

operational work)

(1 Yes — a copy of the receipted QLeave form is attached to this development application

(J No —1, the applicant will provide evidence that the portable long service leave levy has been paid before the
assessment manager decides the development application. | acknowledge that the assessment manager may
ive a development approval only if | provide evidence that the portable long service leave levy has been paid
Not applicable (e.g. building and construction work is less than $150,000 excluding GST)

Amount paid Date paid (dd/mm/yy) QLeave levy number (A, B or E)

 

 

$

22) |s this development application in response to a show cause notice or required as a result of an enforcement
notice?.

 

 

 

 

 

 

ae ~ show cause or enforcement notice is attached
lo

 

23) Further legislative requirements

ail nmentally relevant activities

23.1) Is this development application also taken to be an application for an environmental authority for an
Environmentally Relevant Activity (ERA) under section 115 of the Environmental Protection Act 1994?

(Yes — the required attachment (form ESR/2015/1791) for an application for an environmental authority
wo this development application, and details are provided in the table below
No

Note: Application for an environmental authority can be found by searching “ESR/2015/1791”" as a search term at www.qid.gov.au. An ERA
requires an environmental authority to operate. See www. business.qid.gov.au for further information.

Proposed ERA number: Proposed ERA threshold:
Proposed ERA name:

CJ Multiple ERAs are applicable to this development application and the details have been attached in a schedule to
this development application.

Hazardous chemical facilities

23.2) Is this development application for a hazardous chemical facility?

(1 Yes - Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this development
p

st

 
 

 
 
 
 
  

 

 

 

 

 
 

lication

Note: See www.business.qid.gov.au for further information about hazardous chemical notifications.

 

 

 

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DA Form 1 — Development application details
Version 1.3— 28 September 2020

Page 9

Clearing native veqetati

23.3) Does this development application involve clearing native vegetation that requires written confirmation that
the chief executive of the Vegetation Management Act 1999 is satisfied the clearing is for a relevant purpose under
section 22A of the Vegetation Management Act 1999?

(1) Yes — this development application includes written confirmation from the chief executive of the Vegetation
Management Act 1999 (s22A determination)
No

Note: 1. Where a development application for operational work or material change of use requires a s22A determination and this is not included,
the development application is prohibited development.
2. See https:/vww.gid.gov.au/environment/jiand/vegetation/applying for further information on how to obtain a s22A determination.

Environmental offsets

23.4) Is this development application taken to be a prescribed activity that may have a significant residual.impact on
a prescribed environmental matter under the Environmental Offsets Act 2014?

(Yes -! acknowledge that an environmental offset must be provided for any prescribed activity assessed as
pv a significant residual impact on a prescribed environmental matter
jo

Note: The environmental offset section of the Queensland Government's website can be accessed at www.qld.gov.au for further information on
environmental offsets.

Koala habitat in SEQ Region

23.5) Does this development application involve a material change of use, reconfiguring a lot or operational work
which, is assessable development under Schedule 10, Part 10.of the Planning Regulation 2017?

(J Yes — the development application involves premises in the koala habitat area in the koala priority area
Ys — the development application involves premises in the koala habitat area outside the koala priority area

No if a koala habitat area determination has been obtained for this premises and is current over the land, it should be provided as part of this
development application. See koala habitat area guidance materials at www.des.g/d.gov.au for further information.

 

 

Water resources

23.6) Does this development application involve taking or interfering with underground water through an
artesian or subartesian bore, taking or interfering with water in a watercourse, lake or spring, or taking
overland flow water under the Water Act 2000?

(J Yes — the relevant template is completed and attached to this development application and | acknowledge that a
relevant authorisation or licence under the Water Act 2000 may be required prior to commencing development

No

Note: Contact the Department of Natural Resources, Mines and Energy at www.dnarme.qid.gov.au for further information.

DA templates are available from https://planning.dsdmip.qid.qov.au/. If the development application involves:

« » Taking or interfering with underground water through an artesian or subartesian bore: complete DA Form 1 Template 7

* — Taking or interfering with water in a watercourse, lake or spring: complete DA Form1 Template 2

®.. Taking overland flow water: complete DA Form 1 Template 3.

23.7) Does this application involve waterway barrier works?

(1 Yes — the relevant template is completed and attached to this development application
Oo. ,
DA templates are available from https:/planning.dsdmip.gid.gov.au/. For a development application involving waterway barrier works, complete
DA Form 7 Template 4. :
Marine activities

23.8) Does this development application involve aquaculture, works within a declared fish habitat area or
removal, disturbance or destruction of marine plants?

(J Yes = an associated resource allocation authority is attached to this development application, if required under
ane Act 1994
lo

 

 

 

Note: See guidance materials at www.daf.gid.gov.au for further information.

 

Page 9
DA Form 1 — Development application details
Version 1.3— 28 September 2020

Page 10

 

Quarry materials from _a watercourse or lake

23.9) Does this development application involve the removal of quarry materials from a watercourse or Jake

under the Water Act 2000?

ae — | acknowledge that a quarry material allocation notice must be obtained prior to commencing development
No

Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.qid.gov.au and www. business. gid.gov.au for further

information,

Quarry materials from land under tidal waters

23.10) Does this development application involve.the removal of quarry materials from land under tidal! water
under the Coastal Protection and Management Act 1995?

(2) Yes — | acknowledge that a quarry material allocation notice must be obtained prior to commencing development
Bio

Note: Contact the Department of Environment.and Science at www.des.gid.gov.au for further information.

Referable dams
23.11) Does this development application involve a referable dam required to be failure impact assessed under
section 343-of the Water Supply (Safety and Reliability) Act 2008 (the Water Supply Act)?

(Yes — the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the Water
Supply Act is attached to this development application
lo
Note: See guidance materials at www.dnrme.gid.gov.au for further information.

Tidal work or development within a coastal management district

23.12) Does this development application involve tidal work or development in a coastal management district?

(2 Yes — the following is included with this development application:

(1 Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required
if application involves prescribed tidal work)

a A certificate of title
lo

Note: See guidance materials at www.des.gld.qov.au for further information.
Queensland and local heritage places

 

23.13) Does this development application propose development on or adjoining a place entered in the Queensland
heritage register or on a place entered in-a local government's Local Heritage Register?

Oe — details of the heritage place are provided in the table below
oO

Note: See guidance materials at www.des.qid.gov.au for information requirements regarding development of Queensland heritage places.

 

 

Name of the heritage place:
eikeydneyed

23.14) Does this development application involve a material change of use fora brothel?

(1 Yes - this development application demonstrates how the proposal meets the code for a development
oe for a brothel under Schedule 3 of the Prostitution Regulation 2014
No

Decision under section 62 of the Transport Infrastructure Act 1994
23,15) Does this Reena: Pisin fee ees eee Pee er ce eons hie ce

(1 Yes - this application will be taken to be an application for a decision under section 62 of the Transport
Infrastructure Act 1994 (subject to the conditions in section 75 of the Transport Infrastructure Act 1994 being
isfied)

No

 

 

 

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DA Form 1 - Development application details
Version 1.3— 28 September 2020

Page 11

Walkable neighbourhoods assessment benchmarks under Schedule 12A of the Planning Regulation

23.16) Does this development application involve reconfiguring a lot into 2 or more lots in certain residential zones
(except rural residential zones), where at least one road is created or extended?

(1 Yes - Schedule 12A is applicable to the development application and the assessment benchmarks contained in
a 12A have been considered
No

    

Note: See guidance materials at www.planning.dsdmip.qid.gov.au for further information.

PART 8 — CHECKLIST AND APPLICANT DECLARATION

lhave identified the assessment manager in question 15 and all relevant referral
requirement(s) in question 17 [Pes
Note: See the Planning Regulation 2017 for referral requirements

ff 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 Kot applicable

 

 

Supporting information addressing any applicable assessment benchmarks is with the
development application
ves

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 : a

Note: Relevant plans are required to be submitted for all aspects of this development application. For further es

information, see DA Forms Guide: Relevant plans.

The portable tong service leave levy for QLeave has been paid, or will be paid before a Oy
development permit is issued (see 21) lot applicable

 

 
     

25) Applicant declaration

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

rect

ere 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

« 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.

 

 

 

 

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DA Form 1 - Development application details
Version 1.3—- 28 September 2020

Page 12

PART 9 — FOR COMPLETION OF THE ASSESSMENT MANAGER - FOR OFFICE

USE ONLY

 

Date received: Cd 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

 

 

 

 

Description of the work

QLeave notification and payment
Note: For.completion by assessment manager if applicable

 

 

QLeave project number

 

Amount paid ($) |

Date paid (dd/mm/yy)

|

 

Date receipted form sighted by assessment manager

 

Name of officer who sighted the form

 

 

 

 

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DA Form 1 - Development application details
Version 1.3— 28 September 2020

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