Appendix A - DA Form 1

18) Has any referral agency provided a referral response for this development application?
    Yes – referral response(s) received and listed below are attached to this development application
    No
Referral requirement                                 Referral agency                                   Date of referral response



Identify and describe any changes made to the proposed development application that was the subject of the referral
response and the development application the subject of this form, or include details in a schedule to this development
application (if applicable).



PART 6 – INFORMATION REQUEST
19) Information request under Part 3 of the DA Rules
    I agree to receive an information request if determined necessary for this development application
    I do not agree to accept an information request for this development application
Note: By not agreeing to accept an information request I, the applicant, acknowledge:
 that this development application will be assessed and decided based on the information provided when making this development application and
  the assessment manager and any referral agencies relevant to the development application are not obligated under the DA Rules to accept any
  additional information provided by the applicant for the development application unless agreed to by the relevant parties
 Part 3 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules.
Further advice about information requests is contained in the DA Forms Guide.



PART 7 – FURTHER DETAILS
20) Are there any associated development applications or current approvals? (e.g. a preliminary approval)
    Yes – provide details below or include details in a schedule to this development application
    No
List of approval/development             Reference number                      Date                                  Assessment manager
application references
    Approval
                                         MCU15/0311                            22 July 2016                          Denis Wallace
    Development application
    Approval
    Development application

21) Has the portable long service leave levy been paid? (only applicable to development applications involving building work or
operational work)
  Yes – the yellow local government/private certifier’s copy of the receipted QLeave form is attached to this
development application
  No – I, the applicant will provide evidence that the portable long service leave levy has been paid before the
assessment manager decides the development application. I acknowledge that the assessment manager may give a
development approval only if I provide evidence that the portable long service leave levy has been paid
  Not applicable
Amount paid                           Date paid (dd/mm/yy)                             QLeave levy number (A, B or E)
$

22) Is this development application in response to a show cause notice or required as a result of an enforcement notice?
    Yes – show cause or enforcement notice is attached
    No



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                                                                                                      DA Form 1 – Development Application details
                                                                                                                        Version 1.0—3 July 2017