DA Form 1 - s63 · OPW18/0008

Department of Infrastructure, Local Government and Planning

PART 9 — FOR OFFICE USE ONLY

Date received: [sd Reference number(s): |

Prescribed assessment manager

Name of chosen assessment manager

Date chosen assessment manager engaged
Contact number of chosen assessment manager

Relevant licence number(s) of chosen assessment
manager

Description of the work

 

 

 

 

 

 

 

 

 

 

 

 

QLeave project number

Amount paid ($)

Date paid

Date receipted form sighted by assessment manager
Name of officer who sighted the form

 

 

 

 

 

 

 

 

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and all other required development application materials should
be sent to the assessment manager.