DA Form 1

    No
List of approval/development              Reference number                      Date                                 Assessment
application references                                                                                               manager
    Approval
    Development application
    Approval
    Development application

21) Has the portable long service leave levy been paid? (only applicable to development applications involving building work or
     operational work)
    Yes – a copy of the receipted QLeave form is attached to this development application
    No – I, the applicant will provide evidence that the portable long service leave levy has been paid before the
    assessment manager decides the development application. I acknowledge that the assessment manager may
    give a development approval only if I provide evidence that the portable long service leave levy has been paid
    Not applicable (e.g. building and construction work is less than $150,000 excluding GST)
Amount paid                            Date paid (dd/mm/yy)                             QLeave levy number (A, B or E)
$

22) Is this development application in response to a show cause notice or required as a result of an enforcement
notice?
    Yes – show cause or enforcement notice is attached
    No

23) Further legislative requirements
Environmentally relevant activities
23.1) Is this development application also taken to be an application for an environmental authority for an
Environmentally Relevant Activity (ERA) under section 115 of the Environmental Protection Act 1994?
    Yes – the required attachment (form ESR/2015/1791) for an application for an environmental authority
    accompanies this development application, and details are provided in the table below
    No
Note: Application for an environmental authority can be found by searching “ESR/2015/1791” as a search term at www.qld.gov.au. An ERA
requires an environmental authority to operate. See www.business.qld.gov.au for further information.
Proposed ERA number:                                                    Proposed ERA threshold:
Proposed ERA name:
    Multiple ERAs are applicable to this development application and the details have been attached in a schedule to
    this development application.
Hazardous chemical facilities
23.2) Is this development application for a hazardous chemical facility?
    Yes – Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this development
    application
    No
Note: See www.business.qld.gov.au for further information about hazardous chemical notifications.




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                                                                                                    DA Form 1 – Development application details
                                                                                                             Version 1.3— 28 September 2020