06/1266 - Op Works Transport Type 5 Domestic Marine [As Published] · 142006.1266

(INTEGRATED PLANNING ACT 1997 Parl €, Version 2.0, 4 October 2004

by law lo ‘sight’ an approved form, issued by 15, Has the PLSL levy been paid?
Qleave, which signifies that the PLSL levy
has been paid. (71 YES - completes
| NO - the applicable levy must be paid before a development permit can be given for the works

6. How much was paid?
| _]

7. Whatis the receipt number of the payment?

L. |

PLEASE NOTE

This application cannot be accepted unless accompanied by Part A of Form t.

The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide all applicable information
requested by Part A and any other relevant part of Form 1.

 

 

 

 

OFFICE USE ONLY (applicable to assessment manager)
[ DATE RECEIVED | | REFERENCE NUMBERIS ! |
io Is a PLSL levy applicable in this instance? CINo (YES - compiote a(i)

 

~ manager’ private certifier at the time of lodgement of this application? Ono [YES - provide receipt details below

4

(ii) Has the approved form (issued by QLeave and which signifies that the PLSL levy has been paid) been sighted by the assessment \. @