10/0783 - Transport Type 5 [As Published] · 142010.783

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

 

Date receipted .
QlLeave Project [Amount form sighted by|Name of officer who
Number paid ($) assessment —_isighted the form

. : manager

Description of the work Date paid

 

 

 

 

 

 

 

 

 

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. . ,

 

Application Details - DAS form 1
Version 1.0 18 December 2009