20190520 - DA Form 1 - NSC Operational Works Application for Private Use - Jetty · 132002.220015.1

PART 9 – FOR OFFICE USE ONLY
Date received:                                   Reference number(s):

Notification of engagement of alternative assessment manager
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

QLeave notification and payment
Note: For completion by assessment manager if applicable
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




                                                                                                          Page 12
                                                                        DA Form 1 – Development Application details
                                                                                      Version 1.1— 22 JUNE 2018