Ccf_000013

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Department of Infrastructure, Local Government and Planni

PART 2 — LOCATION DETAILS

   
  
    
      

Street address AND lot on plan (all Jots must be listed), OF

(J Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in water
but adjoining or adjacent to land e.g. jetty, pontoon; all lots must be listed).

Unit No. | Street No. | Street Name and Type
a Supplejyocl€ Couct
Postcode | Lot No. Plan Type and Number (e.g. RP, SP)
4563 | 3S Mev i7/aszb
Unit No. | Street No. | Street Name and Type

 
  
    

 
         
  

Suburb
Lolle Macdonald
Local Government Area(s)

No00SA_SHTRE
Suburb

      
  

     

 

    
  
  

 

    
    
    

a)

 

     
  

     
  

        
     
    
  

    

      
  
       
  

Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)

  
   
   
  
  

Coordinates of premises by longitude and latitude
Longitude(s) Latitude(s)

152..93%8( -26.304S2

 
  

Datum
(J wese4
(J GDA94
(J Other:

Local Government Area(s) (if applicable)

    
 
    

   
          

WME0CSn SHATRE |

   

  

(J Coordinates of premises by easting and northing
Easting(s) Northing(s) Zone Ref.
C54

(55
C1 56

 
    
 

    
 

    
    
 
     
 
 
    

Datum

(1 wese4
C1 Gba94
CJ Other:

    
 
  
 

Local Government Area(s) (if applicable)

 

  

   

 

  

C1 Additional premises are relevant to this development application and their details have been attached in a schedule

ale application
Not required

Ao Kel) FI O e follo g that app o the pre es and provide a elevant deta

 
 

C1 In or adjacent to a water body or watercourse or in or above an aquifer

 

 

 

Name of water body, watercourse or aquifer: an
(J On strategic port land under the Transport Infrastructure Act 1994
Lot on plan description of strategic port land: ———

 

Name of port authority for the lot:
CJ In a tidal area

Name of local government for the tidal area (if applicable): —-
Name of port authority for tidal area (if applicable):
(J On airport land under the Airport Assets (Restructuring and Disposal) Act 2008
Name of airport:

(J Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994

sy easter cogree es a ees [ —_—

 

 

 

 

 

 

 

 

 

 

 

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Department of Infrastructure, Local Government and Planni

 

 

( Listed on the Contaminated Land Register (CLR) under the Environmental Protection Act 1994
CLR site identification: [

 

 

 

 

    
       
 

5) Are there any existing easements over the cna ota

Note: Easement uses vary throughout Queensland and are to be identified correctly and accurately. For further information on easements and how
they may affect the proposed development, see DA Forms Guide.

C1 Yes — All easement locations, types and dimensions are included in plans submitted with this development

application
[No

PART 3 — DEVELOPMENT DETAILS

 

Section 1 — Aspects of development
6.1) Provide details about the first development aspect

 

a) What is the type of development? (tick only one box)

 

( Material change of use ( Reconfiguring a lot [MGpertions! work C1 Building work
oe. is the approval type? (tick only one box)
evelopment permit C Preliminary approval (1 Preliminary approval that includes

a variation approval

ee is the level of assessment?
Code assessment CJ Impact assessment (requires public notification)

d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
lots):

 

 

Drive wes ond fire feos I improvements

 

e) Relevant plans
Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms quide:
Re int plans.

.clevant plans of the proposed development are attached to the development application
6.2) Provide details about the second development aspect

a) What is the type of development? (tick only one box)

 

 

“a
C Material change of use C Reconfiguring a lot ___-_perational work C1 Building work
b) What is the approval type? (tick only one box)
CJ Development permit (1 Preliminary approval C Preliminary approval that includes a variation
approval

 

c) What is the level of assessment?
_-ade assessment CJ Impact assessment (requires public notification)
d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3 lots)

 

_ parr STIPE onseT yer La renp” ovu Mery were ~~
A ww
e) Relevant plans f v

Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms Guide:
Relevant plans.

.xelevant plans of the proposed development are attached to the development application

 
 
 
  

 

6.3) Additional aspects of development

CJ Additional aspects of development are relevant to this development application and the details for these aspects
He cee be required under Part 3 Section 1 of this form have been attached to this development application
Not required

 

 

 

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Department of Infrastructure, Local Government and Planni

 

Section 2 — Further development details
7) Does the proposed development application involve any of the following?

   

  
     

 

 

 

Material change of use C1 Yes — complete division 1 if assessable against a local planning instrument
Reconfiguring a lot O Yas — complete division 2

Operational work Yes — complete division 3

Building work (1 Yes — complete DA Form 2 — Building work details

 

 

 

Division 1 — Material change of use
Note: This division is only required to be completed if any part of the development application involves a material change of use assessable against a local
planning instrument.

8.1) Describe the proposed material change of use
Provide a general description of the Provide the planning scheme definition Number of dwelling Gross floor
proposed use (include each definition in a new row) units (if applicable) area (m?)

ae (if applicable)

 
 
    

 
 
   

  

 

 

 

 

 

 

8.2) Does the proposed use involve the use of existing buildings on the premises?

 

(Yes

 

 

 

 

(No

 

Division 2 — Reconfiguring a lot
Note: This division is only required to be completed if any part of the development application involves reconfiguring a lot.

9.1) What is the total number of existing lots making up the premises?

   
   
  
     
   

OD AY aeLa oe aloe aCe Meum tal—ale)' reconfiguration? (tick all applicable boxes)
(J Subdivision (complete 10)) oO Dividing land into parts by agreement (complete 11))

(J Boundary realignment (complete 12)) '{_] Creating or changing an easement giving access to a lot from
a construction road (complete 13))

 

 

 

10) Subdivision
10.1) For this development, how many lots are being created and what is the intended use (o) ih Unres— wo)

Intended use of lots created Residential | Industrial Other, please specify:

 

 

Number of lots created

10.2) Will the subdivision be staged?

C1 Yes — provide additional details below
(No

How many stages will the works include?

What stage(s) will this development eee te
apply to? =

 

 

 

 

 

Intended use of parts created Residential Commercial rial Other, please specify:

 

 

 

 

 

 

Number of parts created — |

 

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Department of Infrastructure, Local Government and Planni

42) Boundary realignment

   

12.1) What are the current and proposed areas for each lot comprising the premises?
Current lot - Proposed lot
Lot on plan description Area (m?) plan description Area (m?)

 

 

 

 

 

 

 

 

 

 

  

13) What are the dimensions and nature of any existing easements being changed and/or any proposed easement?
(attach schedule if there are more than two easements)

Existing or Width (m) | Length (m) | Purpose of the easement? (e.g. Identify the land/lot(s)
proposed? pedestrian access) _ benefitted by the easement

       
 

  

      

 

 

 

 

 

 

 

 

 

Division 3 — Operational work
Note: This division is only required to be completed if any part of the development ap plication involves operational work.

14.1) What is the nature of the operational work?

    
    
 

   
 
   

    
 
    
  

 

Bee work CO Stormwater C1 Water infrastructure
Drainage work CO Earthworks LC Sewage infrastructure
(er Candsesaitg CI Signage ( Clearing vegetation

 

CJ Other — please specify: [or ve wey and fire trol heading ado prope ty

  

14.2) Is the operational work necessary to facilitate the creation of new lots? (e.g. subdivision)
(1 Yes - specify number of new lots:
Mo

14.3) What is the monetary value of the proposed operational work? (include GS
$S,00¢

PART 4 —- ASSESSMENT MANAGER DETAILS

 

       
 
   

 

 

T, materials and labour)

 
 

15) Identify the assessment manager(s) who will be assessing this development application

16) Has the local government agreed to apply a superseded planning scheme for this development application?

(J Yes — a copy of the decision notice is attached to this development application

C1 Local government is taken to have agreed to the superseded planning scheme request — relevant documents
attached

No

 

PART 5 — REFERRAL DETAILS

     

17) Do any aspects of the proposed development require referral for any referral requirements?
Note: 4 development application will require referral if prescribed by the Planning Regulation 2017.

[WNo, there are no referral requirements relevant to any development aspects identified in this development
application — proceed to Part 6

Matters requiring referral to the chief executive of the Planning Regulation 2017:

CJ Clearing native vegetation
(—] Contaminated land (unexploded ordnance)

     
   
 
   
    
 

 
 

 

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Department of Infrastructure, Local Government and Planni

CJ Environmentally relevant activities (ERA) (only if the ERA have not been devolved to a local government)

C Fisheries — aquaculture

C Fisheries — declared fish habitat area

(1 Fisheries — marine plants

C Fisheries — waterway barrier works

CJ Hazardous chemical facilities

( Queensland heritage place (on or near a Queensland heritage place)

(J Infrastructure — designated premises

(J Infrastructure — state transport infrastructure

(CJ Infrastructure — state transport corridors and future state transport corridors

CJ Infrastructure — state-controlled transport tunnels and future state-controlled transport tunnels

C Infrastructure — state-controlled roads

(J Land within Port of Brisbane’s port limits

(1 SEQ development area :

(C1 SEQ regional landscape and rural production aréa or SEQ Rural living area — community activity
(J SEQ regional landscape and rural production area or SEQ Rural living area — indoor recreation
(1 SEQ regional landscape and rural production area or SEQ Rural living area — residential development
CJ SEQ regional landscape and rural production area or SEQ Rural living area — urban activity

[J] Tidal works or works in a coastal management district

(J Urban design

C water-related development — taking or interfering with water

( Water-related development — removing quarry material (from a watercourse or lake)

(J Water-related development — referable dams

(J Water-related development — construction of new levees or modification of existing levees (category 2 or 3 levees only)
C1 Wetland protection area

 

Matters requiring referral to the local government:

 

O Airport land
C Environmentally relevant activities (ERA) (only if the ERA have been devolved to local government)
C Local heritage places

 

Matters requiring referral to the chief executive of the distribution entity or transmission entity:
C Electricity infrastructure

 

Matters requiring referral to:

e The chief executive of the holder of the licence, if not an individual ve
e The holder of the licence, if the holder of the licence is an inayat
CJ Oil and gas infrastructure

 

Matters requiring referral to the Brisbane City Council: ue
(Brisbane core port land

 

Matters requiring referral to the Minister under the Transport Infrastructure Act 1994:
C Brisbane core port land
CO Strategic port land

 

Matters requiring referral to the relevant port operator:
(Brisbane core port land (below high-water mark and within port limits)

 

Matters requiring referral to the chief executive of the relevant port authority:
C Land within limits of another port

 

Matters requiring referral to the Gold Coast Waterways Authority: j
(J Tidal works, or development in a coastal management district in Gold Coast waters

 

Matters requiring referral to the Queensland Fire and Emergency Service:

 

 

 

(J Tidal works, or development in a coastal management district

 

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Department of Infrastructure, Local Government and Planni

18) Has any referral agency provided a referral response for this development application?
he — 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).

 

 

 

a

PART 6 — INFORMATION REQUEST

    
 

 
 
    
      

19) Information request under Part 3 of the DA Rules

[Wl agree to receive an information request if determined necessary for this development application
(11 do not agree to accept an information request for this development application
Note: By not agreeing to accept an information request |, the applicant, acknowledge:

e 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

e 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

         

20) Are there any associated development applications or current approvals? (e.g. a preliminary approval)
[YW Yes — provide details below or include details in a schedule to this development application
(No

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

 
     

 

 

 

 

LY Approval ae MCvI7/OS 2b ye yl nelon
Development application Koschade
C1 Approval Billy Cles—

 

 

CL] Development application

 

    

21) Has the portable long service leave levy been paid? (only applicable to development applications Vee M ICI MU Lei aelh
operational work)

(J Yes — the yellow local government/private certifier's copy of the receipted QLeave form is attached to this
development application

(J No -1, 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
ao approval only if | provide evidence that the portable long service leave levy has been paid

Not applicable

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

   

 

 

 

 

 

22) Is this development application in response to a show cause notice or required as a result of an enforcement notice?
a — show cause or enforcement notice is attached
No

 

 

 

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Department of Infrastructure, Local Government and Planni

23) Further legislative requirements

Environmentally relevant activities

   

23.1) Is this development application also taken to be an application for an environmental authority for an
Environmentally Relevant Activity (ERA) under section 115 of the Environmental Protection Act 1994?

(Yes — the required attachment (form EM941) for an application for an environmental authority accompanies this
= ea application, and details are provided in the table below
No

Note: Application for an environmental authority can be found by searching “EM941” at www.qid.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:

Oo Multiple ERAs are applicable to this development application and the details have been attached in a schedule
to this development application.

Hazardous chemical facilities

 

 

 

 

    
   
   

23.2) Is this development application for a hazardous chemical facility?
(J Yes — Form 69: Notification of a facility exceeding 1 0% of schedule 15 threshold is attached to this development

a
No

Note: See wwwjustice.gid.gov.au for further information.

 

 

Clearing native vegetation

23.3) Does this development application involve clearing native vegetation that requires written confirmation the chief
executive of the Vegetation Management Act 1999 is satisfied the clearing is for a relevant purpose under section 22A
of the Vegetation Management Act 1999?

C1 Yes - this development application is accompanied by written confirmation from the chief executive of the
Ve. tion Management Act 1999 (s22A determination)
No
Note: See www.gid.gov.au for further information.
Environmental offsets

23.4) Is this development application taken to be a prescribed activity that may have a significant residual impact on a
prescribed environmental matter under the Environmental Offsets Act 2014?

(1 Yes — | acknowledge that an environmental offset must be provided for any prescribed activity assessed as having a
a 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.

Koala conservation

23.5) Does this development application involve a material change of use, reconfiguring a lot or operational work within
an assessable development area under Schedule 10, Part 10 of the Planning Regulation 2017?

Oy¥s

[Mf No

Note: See guidance materials at www.ehp.gld.gov.au for further information.

 

Water resources

23.6) Does this development application involve taking or interfering with artesian or sub artesian water, ich aiire mols
NCUA AVAL CMR Lcero) col Lol spring, taking overland flow water or waterway eet mel oie

— the relevant template is completed and attached to this development application

Note: DA templates are available from www.dilgp.qid.gov.au.

23.7) Does this application involve taking or interfering with artesian or sub artesian water, taking or interfering
with water in a watercourse, lake or spring, or taking overland flow water under ial cael aCe Oleg
nd ae

 

Fe ALE ee BRI Ak Apotoe alithaneation under the Water Act 2000 may be required orior to

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Department of Infrastructure, Local Government and Planni

 

a development
No

Note: Contact the Department of Natural Resources and Mines at www. dnrm.qid.gov.au for further information.

   
    
   

Marine activities

23.8) Does this development application involve PCE MoM UNC Mee CUM MIC LLC Ur Mele removal,
disturbance or destruction of marine plants?

(J Yes — an associated resource allocation authority is attached to this development application, if required under the

eee Act 1994
No

Note: See guidance materials at www.daf.qld.gov.au for further information.
Q

23.9) Does this development application involve the removal of quarry materials from a watercourse or lake under
the Water Act 2000?

Ee — | acknowledge that a quarry material allocation notice must be obtained prior to commencing development
No

     
 

uarry materials from a watercourse or lake

 

  

 

Note: Contact the Department of Natural Resources and Mines at www.dnrm.gid.gov.au for further information.
Quarry materials from land under tidal waters

    
  

 

23.10) Does this development application involve the removal of quarry materials from land under tidal water under
the Coastal Protection and Management Act 1995?

Note: Contact the Department of Environment and Heritage Protection at www.ehp.qid.gov.au for further information.

— | acknowledge that a quarry material allocation notice must be obtained prior to commencing development

   

 

    
     
      
 
 

Referable dams

 
   

23.11) Does this development application involve a referable dam required to be failure impact assessed under
section 343 of the Water Supply (Safety and Reliability) Act 2008 (the Water Supply Act)?

(J Yes - the ‘Notice Accepting a Failure Impact Assessment from the chief executive administering the Water Supply
ae to this development application
No

Note: See guidance materials at www.dews.qid.qov.au for further information.
Tidal work or development within a coastal management district

23.12) Does this development application involve tidal work or development in a coastal management district?

 

(Yes - the following is included with this development application:

(J Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required if
application involves prescribed tidal work)

ae A certificate of title
No

Note: See guidance materials at www.ehp.gid.gov.au for further information.

   
   

Queensland and local heritage places
23.13) Does this development application propose development on or adjoining a place entered in the Queensland
heritage register or on a place entered ina local government's Local Heritage Register?

C1 ¥és — details of the heritage place are provided in the table below
No
Note: See guidance materials at www.ehp.gid.gov.au for information requirements regarding development of Queensland heritage places.

Name of the heritage place: Place ID:

 

Peco} tae)
23.14) Does this development application involve a material change of use for a brothel?

C1 Yes ~ this development application demonstrates how the proposal meets the code for a development application
for ghrothel under Schedule 3 of the Prostitution Regulation 2014

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Department of Infrastructure, Local Government and Planni

 

    
     

  

Decision under section 62 of the Transport Infrastructure Act 1994

 

23.15) Does this development application involve new or changed access to a state-controlled road?

(J Yes - this application will be taken to be an application for a decision under section 62 of the Transport
ee Act 1994 (subject to the conditions in section 75 of the Transport Infrastructure Act 1994 being satisfied)

No

   
 

 

PART 8 — CHECKLIST AND APPLICANT DECLARATION

 

24) Development application checklist

| have identified the assessment manager in question 15 and all relevant referral

requirement(s) in question 17 Ves
Note: See the Planning Regulation 2017 for referral requirements

If building work is associated with the proposed development, Parts 4 to 6 of Form 2- (Yes
Building work details have been completed and attached to this development application [Not applicable

 

 

Supporting information addressing any applicable assessment benchmarks is with
development application

Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report [Ves
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 development application

 

 

Note: Relevant plans are required to be submitted for all aspects of this development application. For further [Yes

information, see DA Forms Guide: Relevant plans.

The portable long service leave levy for QLeave has been paid, or will be paid before a Yes
development permit is issued (see 27)) C1 Not applicable

 

   
 

 
 

25) Applicant declaration
[MJ By making this development application, | declare that all information in this development application is true and

corr.

ae an email address is provided in Part 1 of this form, | 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 141 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:

e such disclosure is in accordance with the provisions about public access to documents contained 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

e required by other legislation (including the Right to Information Act 2009); or

e 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.

 

 

 

 

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Department of Infrastructure, Local Government and Planni

 

PART 9 — FOR OFFICE USE ONLY

Date received: C—i«dzs; 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

 

 

 

 

 

 

 

 

 

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.