DA Form

 0 Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994
 EMR site identification:
 ------------------------------ - ------------------------ - -------------------- —.. '--------------- _______ L_______ _________________________________________________
 0 Listed on the Contaminated Land Reg...ter (CLR) uno^r tue Environmental Protection Act 1994
 CLR site identification:                                                                   I

 5) Are there any existing easements over thej>remises?
 Note: Easement uses vary throughout Queensland and,are to be icHSntified co^ctlv^afKieccurateiy For further information oh easements and
 how they may affect the proposed development,. seerDA Forms (Guide         *         ■-      ■                                     ~
 0 Yes - All easement locations, types and dimensions are included in plans submitted with this development
        application
 S 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 onfyG.ie rex)
 0 Material change of use                      0 Reconfir" "Ing a lot -                         O Operational work                           0 Building work
 b) What is the approval type? (tick only one box)
 S Development permit                          0 Preliminary approval                       ' 0 Preliminary aporoval that includes a variation approval
 c) What is the level of assessment?
                                            .W                _ _                            _______ 0___ j
 0 Code assessment                             0 Impact assessment (requirespbolicnotmdation)
 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
    tots):                                                                 r
                                                                                                       •______ _
 e) Rele' ont plans
 Note: Relevant plans are required to be subir&ad for all aspects of this development application. For further information, see OA Forms guide:
       Relevant plans.
I S- Relevant plans of the proposed development a.e atteohed to the development application
  6.2) Provide details about the second^eve^metft-asileg^-                                                                                                                  1
 a) What is the type of development? (tick only one box)
                                                                                                                                                                            J
 0 Material change of use                      0 Reconfiguring a lot                              Operational work                          0 Building work
 b) What is the approval type? (tick only one ‘-'A
 0 Development permit                          0 Preliminary approval                           0 Preliminary approval that includes a variation approval
 c) What is the level of assessment?
 0 Code assessment                             I I 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 '.ot into 3
 tots): '                                                                                                f


 e) Relevant plans
Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms Guide.
      Relevant plans.
 0 Relevant plans of the proposed deveiopmen, a,e attached to the development application


0 Additional aspects of development'are fo-leyai.i to t.iis rfevblopment application and the details for these aspects
  that would be required under Part 3 Section I of this form have been attached to this development application
Q Not required



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