Development Application part 1 · OPW12/0134

DDD
12. Does the proposal include new building work or operational work on the premises? (including any                                                                                              r:

   services)

oNo (g]Yes           -
                         ensure the nature, location and dimensions of proposed works are included in                                                  plans submitted

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


(g] No   -
             Go to question 15                           DYes


15. Has the local government agreed to apply a superseded planning scheme to this application under
   section 96 of the Sustainable Planning Act 2009?                                                                                                                                              ~




(g] No
DYes provide details below
             -




16. 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)

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


                 1   Form 6                                                                                                                     over the counter




                 2   Checklist                                                                                                                  over the counter




                 3   John Norden Plans                                                                                                          over the counter




                                                 .




17. Applicant’s declaration            I
                                           r",       ~::: ’.~] ..:.t 4. ~.   "
                                                                                 ",.
                                                                                 A<~   :   ~~;~.!   ~

                                                                                                        ,;-/~ ’~~ f?~/I;~I~:~~;~; ~:~r~~: j!l...~.’_I~. ,.’tlw~~/!<   ~.

                                                                                                                                                                      .;
                                                                                                                                                                           "


                                                                                                                                                                           "",
                                                                                                                                                                                 ~r>j~1f ~~..
                                                                                                                                                                                 .J!,.....;di. ~N’r,
                                                                                                                                                                                                       ~




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




                                                                                                                                       Application Details                 -
                                                                                                                                                                               IDAS form 1
                                                                                                                                           Version 1.018 December 2009