2303-33746 DA Form1 Application details_3

  I have identified the assessment manager in question 15 and all                     Yes
  relevant referral requirement(s) in question 17
  Note: See the Planning Regulation 2017 for referral requirements
  If building work is associated with the proposed development, Parts                 Yes
  4 to 6 of DA Form 2 – Building Work details have been completed
  and attached to this development application                                        Not applicable
  Supporting information addressing any applicable assessment                         Yes
  benchmarks is with the development application
  Note: This is mandatory and includes any relevant templates under question 23, a
  planning report and any technical reports required by the relevant categorising
  instruments (e.g. local government planning schemes, State Planning Policy, State
  Development Assessment Provisions). For further information, see DA Forms guide:
  Planning Report Template.
  Relevant plans of the development are attached to this                              Yes
  development application
  Note: Relevant plans are required to be submitted for all aspects of this
  development application. For further information, see DA Forms Guide: Relevant
  Plans.
  The portable long service leave levy for Qleave has been paid, or will              Yes
  be paid before a development permit is issued (see 21)
                                                                                      Not applicable


  25) Applicant declaration
     By making this development application, I declare that all information in this development application is true and
   correct.
      Where an email address is provided in Part 1 of this form, I consent to receive future electronic communications
   from the assessment manager and any referral agency for the development application where written information is
   required or permitted pursuant to sections 11 and 12 of the Electronic Transactions Act 2001.
  Note: It is unlawful to intentionally provide false or misleading information.


Privacy—Personal information collected in this form will be used by the assessment manager and/or chosen assessment
manager, any relevant referral agency and/or building certifier (including any professional advisers which may be engaged
by those entities) while processing, assessing and deciding the development application.
All information relating to this development application may be available for inspection and purchase, and/or published on
the assessment manager’s and/or referral agency’s website.
Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Regulation 2017 and
the DA Rules except where:
such disclosure is in accordance with the provisions about public access to documents in the Planning Act 2016 and the
Planning Regulation 2017, and the access rules made under the Planning Act 2016 and Planning Regulation 2017; or
required by other legislation (including the Right to Information Act 2009); or
otherwise required by law.
This information may be stored in relevant databases. The information collected will be retained as required by the Public
Records Act 2002.


PART 9 – FOR COMPLETION OF THE ASSESSMENT MANAGER - FOR OFFICE
USE ONLY
  Date received:                                         Reference number(s):

  Notification of engagement of alternative assessment manager
  Prescribed assessment manager
  Name of chosen assessment manager

                                                                                                                               Page 12
                                                                                            DA Form 1 – Development application details
                                                                                                      Version 1.3—28 September 2020