DA Form

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 Walkable neighbourhoods assessment.benchmarks under Schedule-12A of the Planning Regulation
 23.16) Does this development application involve reconfiguring a lot into 2 or more lots in certain residential zones
 (except rural residential zones), where at least one,road is created or extended?-'
□ Yes - Schedule 12A is applicable to the development application and the assessment benchmarks contained in
schedule 12A have been considered
"0 No
 Note: See guidance materials at www.planning, dsdmip.qld. c.ov.au for further information.
                                                                                                                                               J

PART 8 - CHECKLIST AND APPLICANT DECLARATION

24) Development application checklist
I have identified the assessment manager in question 15 and ait relevant referral
requirement(s) in question 17                                                                                            es
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                              E 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       rCK/es
and any technical reports required by the relevant categorising instruments (e g. local govemmert 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 aspjcts cfthis development application. For further            es
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) ■
                                                                                                                   E Not applicable



0 By making this development appkcation, I declare that all it,formation in this development application is true and
   correct
ET Where an email address is provided in Part 1 of this form, I consent to receive future electronic communications j
   from the assessment manager and any referral agency for the developme u application where written information
   is required or permitted pursuant to sections 11 and 12 of the Electronic Ti .insacticns 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 cbout 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.




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                                                                                                      □A Form 1 - Development application details
                                                                                                                Version 1.3—28 September 2020