Development Application for permit to damage vegetation - OPW13/0009

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12. Is the payment of a portable long service leave levy applicable to this application? (Refer to notes at the end
of this form for more information.)


0’No-go       to question 14       DYes

13. Has the portable long service leave levy been paid? (Refer to notes at the end of this form for more
information.)


D    No


D    Yes-complete Table N and submit with this application the yellow local governmenUprivate certifier’s copy of the
     receipted QLeave form

Table N

Amount paid            Date paid            QLeave project number (6digit number starting with A, B, E, L or P)

                       (dd/mm/yy)




14. Has the local government agreed to apply a superseded planning scheme to this application under section
96 of the Sustainable Planning Act 2009?


~NO
D    Yes-please provide details below


Name of local government                          Date of written notice given    Reference number of written notice given
                                                  by local government            by local government (if applicable)
                                                  (dd/mm/yy)




15. List below all of the forms and supporting information that accompany this application (Include alllDAS
forms, checklists, mandatory supporting information etc. that will be submitted as part of this application. Note: this
question does not apply for applications made online using Smart eDA.)


Description of attachment or title of attachment                                            Method of lodgement to
                                                                                            assessment manager


    ~{~                                                                                     IN     PffiOAl
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 16. Applicant’s declaration
    /


~By making this application, I declare that all information in this application is true and correct (Note:it is unlawful to
provide false or misleading information.)




6                                                                                                IDAS form 1-Application details
                                                                                                  Version 2.017 December 2012