Operational Works Applicaiton, DA Form 1 - OPW21/0249

Department of Infrastructure, Local Government and Plannii

 

18) Has any referral agency provided a referral response for this development application?

 

da — 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

[Y | agree to receive an information request if determined necessary for this development application
(J | 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

e 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

 

 

CD Approval
CJ Development application

LC Approval
LJ Development application

 

 

 

 

 

  

21) Has the portable long service leave levy been paid? (only applicable to development applications involving building work or
operational work)

C1 Yes — the yellow local government/private certifier’s copy of the receipted QLeave form is attached to this
development application

(J No =|, the applicant will provide evidence that the portable long service leave levy has been paid before the
assessment manager decides the development application. | acknowledge that the assessment manager may give a
dévelopment approval only if | 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

 

 

 

Page 7
DA Form 1 — Development Application details
Version 1.0—3 July 2017