DA Form 1 · OPW18/0093

Department of Infrastructure, Local Government and Planni

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

(-] Yes — referral response(s) received and listed below are attached to this development application
[H 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 the development application the subject of this form, or include details in a schedule to this development
application (if applicable).

 

 

 

 

PART 6 — INFORMATION REQUEST

    

19), Information request under Part 3 of the DA Rules

(Z| | agree to receive an information request if determined necessary for this development application
(11 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

« 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.

 

PART 7 — FURTHER DETAILS

20) Are there any associated development applications or current approvals? (e.g. 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 manager
application references .

(CJ Approval Balding Ap Pils DOO 24 ED > sf) ¥
(1) Development application

CJ Approval
(J Development application

 

 

 

 

 

 

 

 

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

 

Rajel-Te- ogre t,9
[1 Yes — the yellow local government/private certifier’s copy of the receipted QLeave form is attached to this
development application

(1 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 give a
development approval only if | provide evidence that the portable long service leave levy has been paid

CJ Not applicable
Amount paid Date paid (dd/mm/yy) QLeave levy number (A, B or E)

$ U Cas 14) lis SIS 26) 2

 

 

 

 

 

 

22).1s this development application in response to a show te Bee or required as a result of an enforcement notice?
C1 Yes — show cause or enforcement notice is attached

[A No

 

 

 

 

Page 7
DA Form 1 — Development Application details
Version 1.0—3 July 2017