DA Form 1 - Secondary Crossover application · OPW20/0138

List of approval/development Reference number Date

Assessment
application references

manager
Approval
Development application

Approval
Development application

Iam erele tant

 

Yes — a copy of the receipted QLeave form is attached to this development application
No — |, the applicant will provide evidence that the portable long service leave levy has beén 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
ot applicable (e°9, 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)

 

Yes — show cause or enforcement notice is attached
<No >

jon for an

 

Yes — the required attachment (form ESR/2015/1791) for an application for an environmental authority accompanies
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 An ERA
requires an environmental authority to operate. See for further information.
Proposed ERA number: Proposed ERA threshold:

Proposed ERA name:

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

Hazardous chemical facilities

5

 

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

Yes — Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this development
plication

N
' Note: See for further information about hazardous chemical notifications.

Page 10
DA Form 1 — Development application details
Version 1.2— 7 February 2020