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10/0760 - Operational Works - Jetty [As Published] · 142010.760
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QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)
Date receipted
age QLeave Project |Amount _4 |form sighted by|Name of officer who
Description of the work Number paid ($) Date paid assessment {sighted the form
manager
The Sustainable Planning Act 2009 (SPA) is administered by the Department of Infrastructure and Planning. This
form and ail other required application materials should be sent to your assessment manager and any réferral
agencies.
Application Details - IDAS form 1
Version 1.0 18 December 2009
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