Development Application Part 1 of 2 - IDAS Forms 1 and 6 - OPW13/0308

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


IZI     No-go to question 14         DYes

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


IZI     No


o Yes-complete Table N and 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, S, E, L or P)

                        (dd/mm/yy)




14. Has the local govemment agreed to apply a superseded planning scheme to this application under section
96 of the Sustainable Planning Act 20091


IZI     No


o       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 fonns and supporting information that accompany this application (Indude 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 eOA.)

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


(1)Plans & specifications relevant to the proposed works.                                     Email for printing if required.


(2)IDAS Form 6                                                                                Email for printing if required.




16. Appllcanfs declaration                          iU
                                                         ~




IZI 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 2.0 17 December 2012