001ABA64.001

“~       INTEGRATED PLANNING ACT 1997                                                                                   Part A, Version 3.1, 3 March 2008
            Attachments and supporting information {Complete Table |    Use a separate sow for each type of attachment or information, including information "required Biel
            lunde his Par). Please’ ensure al acumaton submited wih tis fom, ining other Pets of Frm. or owner's consent ef are securely atthe tots Pato the Form.
                                [gee Description of attachment or information "Se)y “Nae Tite ir appicabley Sean |     8 Method of delivery to.
            Table |             _ (09. Parl C of Farm 1 owners consent evienes ofresouree. |. 6 General authonly Jams SteetTiaic Repord | *” DSC 4 < |-aeéecement manager | |
                                Hao @allocationfentitement plans, drawings, reports) WIE]. intowaatlar < navraaRe A LeBeate | Gy Saw ES | csmeenanaiy. cree es
,                               PART P OF FORM 1                              PRECRIBED TIDAL WORhS                 11-Mar-2009 |mat
,                       [2 — [ASSESSMENT CHECHLIST                                           ee
                                ENGINEERS CERTIFICATE                         CARDNO (QLD) PTY LTO                 09-Mar-2009 mai! =
                        [4    | SITE & WATER ALLOCATION PLAN                  JSP-SJ-21811 ISSUE A                  24-Feb-2009 |mall =
                                LAYOUT & ELEVATION PLAN                       JSP-SJ-21810 ISSUE B                 02-Mar-2009 |mail =
            Portable Long Service Leave (PLSL) levy. (Applicable fr certain bulding and construction work valued over $60,000 on) amc hyenas, atte
            10.   The Portable Long Service Leave Levy (PLSL) is not applicable to this application if any of the following apply: ( Tick box if applicable)
                  [_] the application seeks a preliminary approval only;
                  [] the application is not for building and construction work under the Building and Construction Industry (Portable Long Service
                       Leave) Act 1991, section 3AA (e.g. the application is only for a change of use, or for the following types of work carried out solely for
                       farming purposes: land clearing, site preparation, earthworks, fences, fodder harvesting, clearing of encroaching vegetation, clearing of
       @               regrowth, thinning vegetation or controlling weeds or pests);
                   (X all costs, that relate to the work both directly and indirectly, are less than 480,000, inclusive of GST: or
                  [_] the work is being carried out under an owner-builder permit issued under the Queensiand Building Services Authority Act 1991 -
                       Complete and submit a QLeave Notification and Payment Form (no payment required if owner-builder permit number stated). The receipted form must be
                       sighted by the assessment manager before a development permit can be given.                                        a                    .
            11.    Is payment of a PLSL levy applicable to this application? (Refer to Q10 and the Advice below for more information)?    .
                     DX]   No - End of Part A
                    Cf     Yes - Answer Q12 below
            OFFICE USE ONLY (For use by the Assessment Manager / Private Certifier) (Optional)
                                             ;                         Receiving officer's Ih                         Reference
              Fee (9)/2.Q 0 | Date received        244      a                name                    Ae —              numbers      oF / TU
                                                NOTIFICATION OF ENGAGEMENT OF PRIVATE CERTIFIER | TUS                                   Sra a)
            AP tee        st Wit         a   ee      NOTIFICATION OF      ENGAGEMENT OF PRIVATE CERTINER                            eee ee
           To: fea 'have been engaged as the private certifier for the building work referred to in this application.
              ge Date oF BE | Reh sche        Raa, Saisie Tar La        Ah aaa        SN, ge eee nai] GN oN ANNI      late     ay ag          icatone el
             pees ie Fe fe pe Le Name pot : fo a eae e BSA Certification number : r F bulgrg ‘classticatonis :
            jeengagement bi aii a till      ears MSG       aU anelE al ESA Re         RE nie     vel [Acuna sate lipns nS    rs  RM      oct oxalWi te

                            QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)
                            Srnee         ne. et RO RRR | Rese: |                             es | Date receipted.:) age Se aie                    eee
                            ai ee ee               Mou i a ae                   ee ea                       ‘1: form:sighted: by Nate foes oe oncrtet
                              ee Dect plore the wor ay es Queave Frokeet Number > amount pad (8) | Datespaid “essessment |       5 ei tombani es                .
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             Privacy Statement                                                                                                                                 ,
             The information collected on Form 1 will be used by the Department of infrastructure and Planning (DIP) in accordance with the processing and assessment of your Application.
             Your personal details will not be disclosed for a purpose outside of the IDAS process, except where required by tegistatin (including the Freedom of Information Act 1992} or as
             required by Parliament. This information may be stored in @ DIP database. The information. collected will be retained as required by the Public Records Act 2002.
             Advice for completing Part A