Operational Works Application OPW18/0075 - DA Form1 and Plan -3 The Anchorage, Noosaville

                                                                          Department of Infrastructure, Local Government and Planning


PART 9 - FOR OFFICE USE ONLY

 Date received:      ________                  1   Reference number(s):


 Notification of engagement     of alternative assessment manager
 Prescribed assessment manager
 Name of chosen assessment manager
 Date chosen assessment manager engaged
 Contact number of chosen assessment manager
 Relevant licence number(s) of chosen assessment
 manager


 QLeave notification and payment
 Note For completIOn by assessment manager,f applicable

 Description of the work
 QLeave project number
 Amount paid ($)
 Date paid
 Date receipted form sighted by assessment manager
 Name of officer who sighted the form

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and all other required development application materials should
be sent to the assessment manager.




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                                                                                           DA Form 1 - Development Application details
                                                                                                             Version 1.0-3 July 2017