DA Form 1

List of approval/development Reference number Date Assessment manager
application references

Approval Mua foo! d{7/>)

Development application

 

Approval
Development application

 

Yes — a copy of the receipted QLeave form is attached to this development application
No — |, the applicant will provide evidence that the portable long service leave levy has been paid before the
assessment manager decides the development application. | acknowledge that the assessment manager may give
a development approval only if | provide evidence that the portable long service leave levy has been paid
jot 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)

 

 
   

Yes — show cause or enforcement notice is attached

FR No

 

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.gid.gov.au. An ERA requires
an environmental authority to operate. See www.business.gid.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.

    

Yes — Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this development
application

No

Note: See www business. gid. gov.au for further information about hazardous chemical notifications.

 

Yes — this development application includes written confirmation from the chief executive of the Vegetation
Management Act 1999 (s22A determination)

ino

  

Note: 7. Where a development application for operational work or material change of use requires a s22A determination and this is not
included, the development application is prohibited development.
2. See https: Awww.gid.gov.au/environment/land/vegetation/applying for further information on how to obtain a s22A determination.

Yes — | acknowledge that an environmental offset must be provided for any prescribed activity assessed as having a
significant residual impact on a prescribed environmental matter
No

Note: The environmental offset section of the Queensland Government's website can be accessed at www.qld.gov.au for further information on
environmental offsets.