Development Application for permit to damage vegetation - OPW13/0327

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       12. Is the payment of a portable long service leave levy applicable to this application? (Refer to notes at the end
      of this form for more information.)


                      No-go to question 14            DYes
                                                                                                                                   ""-
      J 3. Has the portable long service leave levy been paid? (Refer to notes at the end of this form for more                            J
      information.)
          -:,o..’l:
                                     II




       uz( No
       D              Yes-complete Table N and submit with this application the yellow local government/private certifier’s copy of the
                      receipted QLeave form

      Table N

      Amount paid                         Date paid     QLeave project number (6digit number starting with A, B, E, Lor P)

                                          (dd/mm/yy)




      ~14. Has the local government agreed to apply a superseded planning scheme to this application under section
       96 of the~Sus_tainable Planning Act 200?,?
                                                                             ..




       ~NO
       D              Yes-please provide details below


      Name of local government                                Date of written notice given   Reference number of written notice given
                                                              by local government            by local government (if applicable)
                                                              (dd/mm/yy)




       15. List below all of the forms and supporting information that accompany this application (Include alllDAS
       forms, checklists, mandatory supporting information etc. that will be submitted as part of this application. Note: this
       question does not apply for applications made online using Smart eDA.)


       Description of attachment or title of attachment                                               Method of lodgement to
                                                                                                      assessment manager




..,   I" 16. Applicant’s declaration                                                                                           ~     c1i

                      /


       By making this application, I declare that all information in this application is true and correct (Note:it i~ unlawful to
       [
       provide false or misleading information.)



                      ~CadJ
      6                                                                                                    IDAS form 1-Appl alion details
                                                                                                             Version 2.0 17 December 2012