Revised DA Form 1

Page 2

PART 2 — LOCATION DETAILS

  
 
   

    

CO Street address AND tot on plan (ai! iots must be listed), OF

(Street address AND lot on pian for an adjoining or j Property of the premises (appropriate for development in
water but adjoining or adjacent to land @.g. jetty, pontoon. All lots must be listed).

Unit No. | StreetNo. | Street Name and Type
YATTON EB
Pian Type and Number {e.9. RP, SP)

        
 

     

Suburb

AL 7
Locai Government Area(s)

      
 
  
   
  
    
   

   
  
  
    
  
 

|
|
|
|

       
  

  
   

a)

 

j

   
 

Postcode | Lot No.

Oo
Street No.

    

    
   

Unit No. Street Name and Type Suburb

  
  

     

Postcode | Lot No. Pian Type and Number (e.g. RP, SP) Local Government Areajs)

     
 
 

  

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

  
  

Datum
| Dwese4
| (1 Gbaga
| | C) Other:
C Coordinates of premises by easting and northing
_ Easting(s) | Northing(s) | Zone Ref. | Datum

C54 | Oweses
O55 |()Gpaos
056 | (2D Other:

  

    
  
 

 
 
    

 
  

 

Local Government Area(s) (if applicable) |

   
 

 
     
   
      

C1 Additional premises are relevant to this development application and the details of these premises have beem
attached in a schedule to this development application
(Not required

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

Name of water body, watercourse or aquifer: |

(1 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:

0 tna tidal area

Name of local government for the tidal area (@ 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: [ |

 
 

i

   
 

 

 

 

 

 

 

 

 

 

 

 

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DA Form 1 — Development application details
Version 1.3—- 28 Septernber 2020

Page 3

 

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

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

CLR site identification: [

 

 

 

 

    

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

i application

PART 3 —- DEVELOPMENT DETAILS

 

Section 1 -— Aspects of development

  

8) What is the type of development? (ick only ane bax)
( Material change of use [J Reconfiguring a lot (25 Operational work C1 Building work
b) What is the approval type? jtick only one box)
Ky Development permit (C] Preliminary approval Crem aopl ft nes rton pos
¢) What is the level of assessment? 3 sf 2

Code assessment (7) impact assessment (gure pte rte
be eereae sad a, :

 

 

 

 

   

 

 

   

 

 

 

( Material change of use (J Reconfiguring a lot [operator wr Cuicng work

b) What is the approval type? itik only ane box)

(] Development permit (J Preliminary approval [Primary aprvel at ncues a vrstion approval
c) What is the tevel of assessment?

(1) Code assessment C1 impact assessment (requires public notication)

pa a ata
tots):

 

 

 

 

 

 

 

 

 

 

 

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

Page 4

Section 2 - Further development details

 

 

 

 

 

Material change of use [Yes ~ complete division 1 if assessable against a local planning instrument
Reconfiguring a lot CO Yes - complete division 2

Operational work & Yes — complete division 3

Building work (CD Yes - complete DA Form 2 ~ Building work details

 

Division 1 — Material change of use

Note: This division 'S Only required lo be completed if any part of the development application involves @ material change of use assessable against a
jocal ing instrument.

 
 
 

 
 

 

 

 

 

 

 

 

 

| 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 (7 appiicable) area (m7)
(@ applicabie)
1 Yes
No

 

 

Division 2 — Reconfiguring a lot
Note: This division is oni wired to be

   
 
  

 

 

 

( Subdivision (complete 10)) [1] Dividing land into parts by agreement (complete 11)
( Boundary realignment (complete 12)) ( Creating or changing an easement giving access to a lot
from a constructed road (complete 13))

 

 

  

| Intended use of lots created

 

 

 

| Number of lots created

 

 

   

(C Yes — provide additional details below
C1No
How many stages will the works include?

What stage(s) will this development application
_apply to?

 

 

 

 

 

 

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DA Form 4 ~ Development application details
Version 1.3— 28 September 2020

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Intended use of parts created

 

 

 

 

 

 

 

Number of parts created |

 

Current lot Proposed lot
Lot on plan description Area (m?) Lot on plan description Area (m*)

 

 

 

 

 

 

 

 

 

Length (m)

 

 

 

 

 

 

 

 

 

Division 3 — Operational work

Note. This division is to be ted if arr wt of the jon involves work.
( Road work 0 Stormwater ( Water infrastructure
| C] Drainage work 0 Earthworks i

 

 

 

 

DC Sewage infrastructure
| C) Landscaping CO Signage CO Clearing vegetation
| Other ~ please specify: or WAT Az S STGP
|C Yes ~ specify number of new lots:
i CINe

 
       
 

i$ SOO

PART 4 - ASSESSMENT MANAGER DETAILS

  

C1 Yes — a copy of the decision notice is attached to this development application |
| C1 The local government is taken to have agreed to the superseded planning scheme request ~ relevant documents |
i

 

| attached

5

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DA Form 1 ~ Development application details
Version 1.3— 28 September 2020

Page 6

PART 5 - REFERRAL DETAILS

 

    

No, 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 Act 2016:

| C] Clearing native vegetation

C1 Contaminated tand (unexploded ordnance)

C) Environmentally relevant activities (ERA) (onty if ihe ERA has not been devolved to @ local government)
(CJ Fisheries - aquaculture

C1 Fisheries — declared fish habitat area

L Fisheries - marine plants

0 Fisheries ~ waterway barrier works

(] Hazardous chemical facilities

| C2 Heritage places — Queensiand heritage place (on or near 2 Queensland hentage piace)

 

L] Koala habitat in SEQ region - interfering with koala habitat in koala habitat areas outside koala priority areas
() Koala habitat in SEQ region — key resource areas

(Ports ~ Brisbane core port land — near a State transport corridor or future State transport corridor

C1 Ports ~ Brisbane core port land ~ environmentally relevant activity (ERA)

C1 Ports — Brisbane core port land — tidal works or work in a coastal management district

C1 Ports ~ Brisbane core port land — hazardous chemical facility

( Ports — Brisbane core port land — taking or interfering with water

| C Ports ~ Brisbane core port land — referable dams

C Ports - Brisbane core port land — fisheries

C] Ports — Land within Port of Brisbane's port limits (below nigh-weter mer

| [] SEQ development area

| C1 SEQ regional tandscape and rural production area or SEQ rural living area ~ tourist activity or sport and

CC Reconfiguring a tot in a coastal management district or for a canal

(Erosion prone area in a coastal management district

C Urban design

CJ Water-retated development — taking or interfering with water

C1] Water-related development — removing quarry material (tom « watercourse or eke)
(CO Water-related development — referable dams

C Water-related development levees (category 3 ievees only)

(] Wetland protection area

 

 

Matters requiring referral to the local government:
(CO Airport land

L 0 Environmentally relevant activities (ERA) (only # the ERA has been devolved to jocal govemment)

 

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DA Form 1 ~ Development application details

 

6

Version 1.3— 28 September 2020

Page 7

(1) Heritage places — Local heritage places

| Matters requiring referral to the Chief Executive of the distribution entity or transmission entity:
| CJ Infrastructure-related referrals — Electricity infrastructure

| Matters requiring referral to:

| « The Chief Executive of the hoider of the licence, if not an individual

* The holder of the licence, if the hoider of the licence is an individual

(2 infrastructure-related referrals — Oil and gas infrastructure

Matters requiring referral to the Brisbane City Council:

(0 Ports - Brisbane core port land

Matters requiring referral to the Minister responsible for administering the Transport infrastructure Act 1994:
| (J Ports — Brisbane core port land (where inconsistent with the Brisbane port LUP for transport reasons)

| ( Ports — Strategic port and

Matters requiring referral to the relevant port operator, if applicant is not port operator:

_ ( Ports - Land within Port of Brisbane's port limits (oeiow high-water mark)

| Matters requiring referral to the Chief Executive of the relevant port authority:

| [J Ports — Land within fimits of another port (below nigh-water mark)

| Matters requiring referral to the Gold Coast Waterways Authority:

| C Tidal works or work in a coastal management district (in Gold Coast waters)

| Matters requiring referral to the Queensland Fire and Emergency Service:

| C] Tidal works or work in a coastal management district (involving a marina (more than six vessel berths))

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

(No
Referrai requirement Referral agency Date of referral response

 

 

 

 

 

 

 

 

 

 

 

 

 

\dentify and describe any changes made to the proposed development application that was the subject of the
referral response and this development application, or include details in a schedule to this development application
(if applicable).

 

 

 

 

PART 6 — INFORMATION REQUEST

     

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

| ¢ Part 3 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules.

| parties
| Further advice about information requests is contained in the DA Forms Guide.

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DA Form 1 ~ Development appiication details
Version 1.3-- 28 September 2020

Page 8

PART 7 — FURTHER DETAILS

 

| (2 Yes — provide details below or include details in a schedule to this development application
| CNo

 

 

 

 

 

| List of approval/development | Reference number Date Assessment

| application references | ) manager
Approval Lisk
(Development application RA, pf. oA I/ 0023 27 Jeren6A. 0.90 PIENAAR

| CJ Approval i ,

| C] Development application

 

 

 

| (J Yes — a copy of the receipted QLeave form is attached to this development application

CI No-1, the applicant will provide evidence that the portable long service ieave levy has been paid before the
i 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 (e.g. building and construction work is less than $150,000 excluding GST)
| Amount paid Date paid (dd/mmiyy) QLeave levy number (A, B or E)

 

 

 

 

 

 

 

  

(2 Yes - show cause or enforcement notice is attached

|CNo

 

 

tak ALAe ALAS a leh ce

epee itm aC Acca etka amt do) alts

CJ Yes - the required attachment (form ESR/2015/1781) for an application for an environmental authority

accompanies this development application, and details are provided in the table below
| CINo j
| Note: Appircation for an environmental authority can be found by searching “ESR/2015/1791" 83 @ search term at www cid goy.ay. An ERA |

| requires an environmental authority 10 operate. See www business. oid gov. au for further information. j

| Proposed ERA number: ] _ oo | Proposed ERA threshold: |

| Proposed ERA name: |

| (_] Multiple ERAs are applicable to this development application and the details have been attached in a schedule to

| this development application.

chemical fac

   

 

 

   

 

chemi

Cl ves — Form 69: Nottoeton af 6 Reciay amneatine 10% of schedule 8 Wonahodl i etieched ws tas Govoltarere
application

Ono |

 

 

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DA Form 1 ~ Development application details
Version 1.3~- 28 September 2020

Page 9

Clearing native vegetation

clearing nativ

| (7 Yes — this development application includes written confirmation from the chief executive of the Vegetation
| Management Act 1999 (s22A determination)
LI No
| Note: 1. Where a development application for operational work or material change of use requires 2 S22A determination and this is not included,

the compen ea is prohibited development.
vonmentiand/vegetation/applying tor further information on how to obtain a 822A determination.

 

Environmental offsets

 

ee ene environme ntal matter

| Dar TU nisribstediye tcl eh arieroranertal ott haat bal protded ®rst prescribed acavey nesatsed 6
| — having a significant residual impact on a prescribed environmental matter

| LI No

| Note: eae ea nacional ei aemeanen OMAR eee ene gov ay for further information on

| (1 Yes — the development application involves premises in the koala habitat area in the koala priority area
| (1 Yes — the development application involves premises in the koala habitat area outside the koala priority area
| CINo

| Note: if. koala habitat area determination has been obtained for this premises and is current over the iand, it should be provided as part of this
devaiopment application. See koala habitat area guidance matenals at wow des.gid gov au for further information

ound water throu

é. lake or sprin

 

CI Yes ~ Se ernie ws conadoted arvt ematted tee tevekeginart appieaen wed eckvwoaketen War 3
relevant authorisation or licence under the Water Act 2000 may be required prior to commencing development
| CINo
| Note: Contact the Department of Natural Resources, Mines and Energy al yww.darme. aid gov.au for further information.
| OA templates are available from hites /pianning.dsdmig.gid gov.au/. if the development application involves.
i? Taking or interfering with underground water through an artesian or subartesian bore: complete DA Form 1 Template 1
* Taking or interfering with water in a watercourse, lake or spring: complete DA Formt Template 2
Taking overland flow water. complete DA Form 1 Ternpiate 3.

 

   
 

| clyves— Pe OTArN Unease Chattcled ard ataehad et Ges aedarmere eppaceton

[No
| DA tempiates are avaiable trom bitps /olenning dsdmip.aid.gov.au/. For a development application involving waterway barrier works, complete
| DA Form 1 Template 4.

 

| (Yes - or maaccleled eeciete chiar anGrky = ciaeives w Wile iooticrarerd spphcalior if required under
| the Fisheries Act 1994
| CINo

| Note: Soe guidance materials st wwrw.dal aid gov.au for further information.

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DA Form 1 — Development application detaiis
Version 1.3 28 September 2020

Page 10

Quarry materials from a Eker em

     
   

 

removal of quarry materials from a wate

 

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

'TINo j
i |
| Note: Contact the Department of Natural Resources, Mines and Energy at yor. dorme.o10 90" au and www business gid gov ay for further |
| information. i

Quarry materials from land under tidal waters

as Mae Tay ei ‘he removal of quarry materials from land under tidal water

| (1) Yes - | acknowledge that a quarry material allocation notice must be obtained prior to commencing development |

| C1No |

| Note: Contact the Department of Environment and Science at www.de3.gid 90v.8u for further information. |
Referable dams

referable dam

 

| (0 Yes ~ the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the Water
| Supply Act is attached to this development application
| CJ Ne

| Mote: See guidance materials at yoy dormne.gid.goy.au for further information.

Z ba le Fo deveior
| (1 Yes — the following is included with this development application:
(_ Evidence the proposal meets the code for assessable development that is prescribed tidal work (oniy required
id application involves prescribed tidal work)
i (A certificate of title
j oO No
| Note: See guidance materials at werw. des. gid. gov.au for further information.
Queensland and local heritage places

 

| (1 Yes - this development application demonstrates how the proposal meets the code for a development
| application for a brothel under Schedule 3 of the Prostitution Regulation 2014
(1 No

| (Cl Yes — this application will be taken to be an application for a decision under section 62 of the Transport
| Infrastructure Act 1994 (subject to the conditions in section 75 of the Transport infrastructure Act 1994 being
| Satisfied)

| (No

 

 

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DA Form 1 — Development application detais
Version 1.3— 28 September 2020

Page 11

 
   

( Yes ~ Schedule 12A Is applicable to the development application and the assessment benchmarks contained in
schedule 12A have been considered
CINo |

| Note: See guidance matenals at www. 2ianning dsdmin.2/G.gov.au for further information.

PART 8 — CHECKLIST AND APPLICANT DECLARATION

| have identified the assessment manager in question 15 and ail relevant referral
requirement(s) in question 17 Elves
Note: See the Planning Regulation 2017 for reterral requirements

if building work is associated with the proposed development, Parts 4 to 6 of DA Form 2 — (C1 Yes

Building work details have been completed and attached to this development application EANot applicable
Supporting information addressing any applicable assessment benchmarks is with the

development application

Note: This is a mandatory requirement and includes any relevant templates under question 23, @ planning report & Yes

 

 

Forms Guide: Piganing Ri

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

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

C By making this development application, | declare that all information in this development application is true and

correct

(C] Where 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 11 and 12 of the Electronic Transactions Act 2001

Note: it is uniawful to intentionally provide false or misleading information.

 

 

 

 

 

| 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 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 :

* fequired 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.

 

 

 

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DA Form 1 ~ Development appiication details
Version 1.3— 2B September 2020

Page 12

PART 9 — FOR COMPLETION OF THE ASSESSMENT MANAGER — FOR OFFICE

USE ONLY

 

Date received: | | 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 ($) I

Date paid (dd/mmiyy)

 

Date receipted form sighted by assessment manager

 

Name of officer who sighted the form

 

 

 

 

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DA Form 1 — Development application details
Version 1.3. 28 September 2020