Development Application for permit to damage vegetation - OPW13/0519

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

                                                                      I



     No-go to question 14           D      Yes



13. Has the portable long service leave levy been paid? (Refer to notes at the end of this form for more
information.)
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D    No


D    Yes-complete Table Nand submit with this application the yellow local government/private 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 Has the local government ag reed to apply a superseded planning scheme to this application under section
96 of the Sustainable Planning A ct2009?




D    Yes-please provide details b elow


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 an d supporting information that accompany this application (Include all IDAS
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


                                                                                               1M       Pd2-~y-.J
                                                                                                  }\       c,




 16. Applicant’s declaration                                                                                                        I
    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
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                                                                                                        Version 2.017 December 2012