Mitti St Driveway · OPW19/0168

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 about 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.


PART 9 – FOR OFFICE USE ONLY

Date received:                              Reference
                                            number(s):


Notification of engagement of alternative assessment manager
Prescribed assessment manager

Name of chosen assessment manager
Date chosen assessment manager engaged
Contact number of chosen assessment manager
Relevant licence number(s) of chosen assessment
manager


QLeave notification and payment
Note: For completion by assessment manager if applicable

Description of the work
QLeave project number
Amount paid ($)
Date paid

Date receipted form sighted by assessment
manager
Name of officer who sighted the form




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                                                                   DA Form 1 – Development Application details
                                                                                 Version 1.1— 22 JUNE 2018