DA Form 1 - s63 · OPW18/0008

 

Department of Infrastructure, Loc

 

Matters requiring referral to the Queensland Fire and Emergency Service:

 

O Tidal works, or development in a coastal management district

O Yes - referral response(s) received and listed below are attached to this development application

No
Referral requirement Referral agency Date of referral response

 

 

 

 

 

 

 

 

Identify and describe any changes made to the proposed development application that was the subject of the referral
response and the development application the subject of this form, or include details in a schedule to this development

application (if applicable).

 

 

 

 

PART 6 — INFORMATION REQUEST

  

& | agree to receive an information request if determined necessary for this development application
0 Ido not agree to accept an information request for this development application
Note: By not agreeing to accept an information request |, the applicant, acknowledge:

that this development application will be assessed and decided based on the information provided when making this development application and
the assessment manager and any referral agencies relevant to the development application are not obligated under the DA Rules to accept any
additional information provided by the applicant for the development application unless agreed to by the relevant parties

¢ Part 3 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules.
Further advice about information requests is contained in the DA Forms Guide.

 

PART 7 — FURTHER DETAILS

QO Yes — provide details below or include details in a schedule to this development application

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

 

 

O Approval
O Development application
O Approval
O1 Development application

O1 Yes - the yellow local government/private certifier’s 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. | acknowledge that the assessment manager may give a development approval
only if | provide evidence that the portable long service leave levy has been paid

O Not applicable

Amount paid Date paid (dd/mm/yy) QlLeave levy number (A, B or E)

$