Development Part 1 of 3 · OPW11/0335

QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)


                                                                              Date receipted
                                     QLeave Project    Amount                 form sighted by Name of officer who
             Description of the work                              Date paid
                                     Number            paid ($)               assessment      sighted the form
                                                                              manager




The Sustainable Planning Act 2009 (SPA) is administered by the Department of Infrastructure and Planning. This
form and all other required application materials should be sent to your assessment manager and any referral
agencies.