DA Form

  □ Heritage places - Local heritage places
  Matters requiring referral to the Chief Executive of the distribution entity or transmission entity:
  □ Infrastructure-related referrals - Electricity infrastructure
  Matters requiring referral to:
  • The Chief Executive of the holder cf the licence, 'c not an individual
  • The holder of the licence, if the holder of the licence is an individual
  □ Infrastructure-related referrals - Cil and gas infrastructure
  Matters requiring referral to the Brisbane City Council:
  □ Ports - Brisbane core port land
  Matters requiring referral to the Minister responsible for administering the Transport Infrastructure Act 1994'.
  □ Ports - Brisbane core port land (where inconsistent with the Brisbane port LUP for transport reasons)
  □ Ports - Strategic port land
  Matters requiring referral to the relevant port operator, if applicant is not port operator:
  □ Ports - Land within Port of Brisbane’s port limits (beiow high-water mark)
  Matters requiring referral to the Chief Executive of the relevant port authority:
  □ Ports — Land within limits of another port (below high-water mark)
  Matters requiring referral to the Gold Coast Waterways Authority:
  □ Tidal works or work in a coastal management district (in Gold Coast waters)
  Matters requiring referral to the Queensland Fire and Emergency Service:
  □ Tidal works or work in a coastal management district (involving a marina (more than six vessel berths))

   18) Has any referral agency prayidfed a referral response for this developmemapplicatiorP                                                ■
                                                                                                                                                1 ‘



                              —       ----- ——--------- --            ' .
  I—| Yes - referral response(s) received and listed below a.e attached to this develooment 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 this development application, or include details in a schedule to this development aoplication
  (if applicable).




PART 6 - INFORMATION REQUEST


  S I agree to receive an information request if determined necessary for this development application
  □ I do not agree to accept an information request for this development appL.ation
 Note By not agreeing to accept an information request I, the applicant, acknowledge:
  •     that this development application will be assessed and decided based o, i 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
        padies
   •    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 ccntained in the DA Forms Guide.




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                                                                                                              OA Form 1 - Development application details
                                                                                                                        Version 1.3— 23 September 2020