Development Application forms 1, 23 & 28, Covering Letter · OPW12/0139

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            ODD
     Privacy-the information collected in this form 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 legislation (includingthe Right to Information Act 2009)or as required

     by Parliament. This information may be stored in a departmental database. The information collected will be retained as
     required by the Public Records Act 2002.



     OFFICE USE ONLY

      Date received                   ~.~        ..
                                                      \.~      I Reference   numbers            O’ruo        ’<:""-C,->q


     NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTlFIER
      To

            I                                I   Cou ncll. I have been engaged as the private certifier for the building work referred
                                                 to in this application



                                                                                                                 Building
     Date of engagement        Name                                           BSA Certification license number
                                                                                                                 classification/s




     QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)
                                                                                               Date receipted

                                      QLeave Project           Amount paid                     form sighted by   Name of officer who
     Description of the work                                                      Date paid
                                      Number                   ($)                             assessment        sighted the form
                                                                                               manager




       The Sustainable PlanningAct 2009(SPA)is administered by the Department of Infrastructure and Planning. This form and
       all other required application materials should be sent to your assessment manager and any referral agencies.



                      7                                                                         Application details-/DAS form 1
                                                                                                  Version t.o t8 December 2009