DA Form 1 · MCU19/0008

 Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.qld.gov.au and www.business.qld.gov.au for further
 information.

 Quarry materials from land under tidal waters
 23.10) Does this development application involve the removal of quarry materials from land under tidal water
 under the Coastal Protection and Management Act 1995?
    Yes – I acknowledge that a quarry material allocation notice must be obtained prior to commencing development
    No
 Note: Contact the Department of Environment and Science at www.des.qld.gov.au for further information.

 Referable dams
 23.11) Does this development application involve a referable dam required to be failure impact assessed under
 section 343 of the Water Supply (Safety and Reliability) Act 2008 (the Water Supply Act)?
   Yes – the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the Water
 Supply Act is attached to this development application
   No
 Note: See guidance materials at www.dnrme.qld.gov.au for further information.

 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.des.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.des.qld.gov.au for information requirements regarding development of Queensland heritage places.

 Name of the heritage place:                                                     Place ID:
 Brothels
 23.14) Does this development application involve a material change of use for a brothel?
    Yes – this development application demonstrates how the proposal meets the code for a development
 application for a brothel under Schedule 3 of the Prostitution Regulation 2014
    No
 Decision under section 62 of the Transport Infrastructure Act 1994
 23.15) 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



PART 8 – CHECKLIST AND APPLICANT DECLARATION
 24) Development application checklist
 I have identified the assessment manager in question 15 and all relevant referral
                                                                                                                    Yes
 requirement(s) in question 17


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                                                                                                  DA Form 1 – Development Application details
                                                                                                                Version 1.1— 22 JUNE 2018