DA Form 1.pdf

 Tidal work or development within a coastal management district
 23.12) Does this development application involve tidal work or development in a coastal management district?
     Yes – the following is included with this development application:
           Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required
             if application involves prescribed tidal work)
            A certificate of title
     No
 Note: See guidance materials at www.desi.qld.gov.au for further information.
 Queensland and local heritage places
 23.13) Does this development application propose development on or adjoining a place entered in the Queensland
 heritage register or on a place entered in a local government’s Local Heritage Register?
     Yes – details of the heritage place are provided in the table below
     No
 Note: See guidance materials at www.desi.qld.gov.au for information requirements regarding development of Queensland heritage places.
 For a heritage place that has cultural heritage significance as a local heritage place and a Queensland heritage place, provisions are in place
 under the Planning Act 2016 that limit a local categorising instrument from including an assessment benchmark about the effect or impact of,
 development on the stated cultural heritage significance of that place. See guidance materials at www.planning.statedevelopment.qldgov.au for
 information regarding assessment of Queensland heritage places.

 Name of the heritage place:                                                Place ID:
 Decision under section 62 of the Transport Infrastructure Act 1994
 23.14) Does this development application involve new or changed access to a state-controlled road?
    Yes – this application will be taken to be an application for a decision under section 62 of the Transport
    Infrastructure Act 1994 (subject to the conditions in section 75 of the Transport Infrastructure Act 1994 being
    satisfied)
    No
 Walkable neighbourhoods assessment benchmarks under Schedule 12A of the Planning Regulation
 23.15) Does this development application involve reconfiguring a lot into 2 or more lots in certain residential zones
 (except rural residential zones), where at least one road is created or extended?
    Yes – Schedule 12A is applicable to the development application and the assessment benchmarks contained in
 schedule 12A have been considered
    No
 Note: See guidance materials at www.planning.statedevelopment.qld.gov.au for further information.


PART 8 – CHECKLIST AND APPLICANT DECLARATION
 24) Development application checklist
 I have identified the assessment manager in question 15 and all relevant referral
 requirement(s) in question 17                                                                                           Yes
 Note: See the Planning Regulation 2017 for referral requirements
 If building work is associated with the proposed development, Parts 4 to 6 of DA Form 2 –                               Yes
 Building work details have been completed and attached to this development application                                  Not applicable
 Supporting information addressing any applicable assessment benchmarks is with the
 development application
 Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report          Yes
 and any technical reports required by the relevant categorising instruments (e.g. local government planning
 schemes, State Planning Policy, State Development Assessment Provisions). For further information, see DA
 Forms Guide: Planning Report Template.
 Relevant plans of the development are attached to this development application
 Note: Relevant plans are required to be submitted for all aspects of this development application. For further          Yes
 information, see DA Forms Guide: Relevant plans.
 The portable long service leave levy for QLeave has been paid, or will be paid before a                                 Yes
 development permit is issued (see 21)                                                                                   Not applicable


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Tidal work or development within a coastal management district

23.12) Does this development application involve tidal work or development in a coastal management district?

 

LJ Yes — the following is included with this development application:

CL Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required
if application involves prescribed tidal work)

LC Acertificate of title
KX] No

Note: See guidance materials at www.desi.gid.gov.au for further information.

Queensland and local heritage places

23.13) Does this development application propose development on or adjoining a place entered in the Queensland
heritage register or on a place entered in a local government’s Local Heritage Register?

   

LJ Yes — details of the heritage place are provided in the table below

KX] No

Note: See guidance materials at www.desi.gid.gov.au for information requirements regarding development of Queensland heritage places.

For a heritage place that has cultural heritage significance as a local heritage place and a Queensland heritage place, provisions are in place
under the Planning Act 2016 that limit a local categorising instrument from including an assessment benchmark about the effect or impact of,
development on the stated cultural heritage significance of that place. See guidance materials at www.planning.statedevelopment.qidgov.au for
information regarding assessment of Queensland heritage places.

 

Name of the heritage place: Place ID:

Decision under section 62 of the Transport Infrastructure Act 1994
23.14) Does this development application involve new or changed access to a state-controlled road?

 

LJ Yes - this application will be taken to be an application for a decision under section 62 of the Transport
Infrastructure Act 1994 (subject to the conditions in section 75 of the Transport Infrastructure Act 1994 being
satisfied)

KX] No

Walkable neighbourhoods assessment benchmarks under Schedule 12A of the Planning Regulation

23.15) Does this development application involve reconfiguring a lot into 2 or more lots in certain residential zones
(except rural residential zones), where at least one road is created or extended?

LJ Yes — Schedule 12A is applicable to the development application and the assessment benchmarks contained in
schedule 12A have been considered

KX] No

Note: See guidance materials at www.planning.statedevelopment.gqid.gov.au for further information.

 

 

 

 

PART 8 — CHECKLIST AND APPLICANT DECLARATION

24) Development application checklist

 

| have identified the assessment manager in question 15 and all relevant referral

requirement(s) in question 17 XX] Yes

Note: See the Planning Regulation 2017 for referral requirements

If building work is associated with the proposed development, Parts 4 to 6 of DA Form 2- [Yes

Building work details have been completed and attached to this development application X] Not applicable

 

 

Supporting information addressing any applicable assessment benchmarks is with the
development application

Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report xX Yes
and any technical reports required by the relevant categorising instruments (e.g. local government planning
schemes, State Planning Policy, State Development Assessment Provisions). For further information, see DA

Forms Guide: Planning Report Template.
Relevant plans of the development are attached to this development application

 

 

 

 

Note: Relevant plans are required to be submitted for all aspects of this development application. For further X Yes

information, see DA Forms Guide: Relevant plans.

The portable long service leave levy for QLeave has been paid, or will be paid before a LJ Yes
development permit is issued (see 21) &X Not applicable

 

   

a BD Queensland
Government