Appendix A - DA Form 1 and Owner's Consent

     Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994
 EMR site identification:
     Listed on the Contaminated Land Register (CLR) under the Environmental Protection Act 1994
 CLR site identification:

 5) Are there any existing easements over the premises?
 Note: Easement uses vary throughout Queensland and are to be identified correctly and accurately. For further information on easements and
 how they may affect the proposed development, see DA Forms Guide.
     Yes – All easement locations, types and dimensions are included in plans submitted with this development
           application
     No


PART 3 – DEVELOPMENT DETAILS
Section 1 – Aspects of development
 6.1) Provide details about the first development aspect
 a) What is the type of development? (tick only one box)
     Material change of use                      Reconfiguring a lot                   Operational work                       Building work
 b) What is the approval type? (tick only one box)
     Development permit                          Preliminary approval                  Preliminary approval that includes
                                                                                       a variation approval
 c) What is the level of assessment?
     Code assessment                             Impact assessment (requires public notification)
 d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
 lots):
 Commercial Business – Type 2 Medical (Doctor’s Practice) within an existing building

 e) Relevant plans
 Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms guide:
 Relevant plans.
     Relevant plans of the proposed development are attached to the development application
 6.2) Provide details about the second development aspect
 a) What is the type of development? (tick only one box)
     Material change of use                      Reconfiguring a lot                   Operational work                       Building work
 b) What is the approval type? (tick only one box)
     Development permit                          Preliminary approval                 Preliminary approval that includes a variation
                                                                                   approval
 c) What is the level of assessment?
     Code assessment                             Impact assessment (requires public notification)
 d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
 lots):




 e) Relevant plans
 Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms Guide:
 Relevant plans.
     Relevant plans of the proposed development are attached to the development application




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