Amended DA Form 1 OPW18-0118

Department of Infrastructure, Local Government and Planning

 

PART 9 — FOR OFFICE USE ONLY

Date received: Cd] Reference number(s): [ |

- Notification of engagement of alternative assessment Ueto

 

 

 

  

  

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
C manager

 

 

 

 

 

QLeave notification and payment

  

el eee eae ACC oct lenys AcIEFe1 (JA e)¢)e)f(er=1 0) (3
Description of the work

 

 

QLeave project number

Amount paid ($)

Date paid

Date receipted form sighted by assessment manager
Name of officer who sighted the form

 

 

 

 

 

 

 

 

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and ail other required development application materials should
be sent to the assessment manager.

Page 11
DA Form 1 — Development Application details
Version 1.0—3 July 2017