202004666 - DA Form 1 - Development Application.pdf

PART 8 – CHECKLIST AND APPLICANT DECLARATION

 24) Development application checklist
 I have identified the assessment manager in question 15 and all relevant referral
 requirement(s) in question 17                                                                                           Yes
 Note: See the Planning Regulation 2017 for referral requirements
 If building work is associated with the proposed development, Parts 4 to 6 of DA 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 the
 development application
 Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report          Yes
 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 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 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
 • 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.




                                                                                                                                           Page 11
                                                                                                         DA Form 1 – Development application details
                                                                                                                      Version 1.2— 7 February 2020


[OCR of page images]
PART 8 — CHECKLIST AND APPLICANT DECLARATION

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| have identified the assessment manager in question 15 and all relevant referral
requirement(s) in question 17 XX] Yes
Note: See the Planning Regulation 2017 for referral requirements

If building work is associated with the proposed development, Parts 4 to6 of DA Form2— [_] Yes
Building work details have been completed and attached to this development application XJ Not 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, a planning report O Yes
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 X 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 LC Yes
development permit is issued (see 27) EX] Not applicable

 

25) Applicant declaration

XX] By making this development application, | declare that all information in this development application is true and
correct

XX] 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 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.

 

 

 

 

 

Page 11
DA Form 1 — Development application details
Version 1.2— 7 February 2020