DA Form 1

☐ In a tidal area
Name of local government for the tidal area (if applicable):
Name of port authority for tidal area (if applicable):
☐ On airport land under the Airport Assets (Restructuring and Disposal) Act 2008
Name of airport:
☐ Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994
EMR site identification:
☐ Listed on the Contaminated Land Register (CLR) under the Environmental Protection Act 1994
CLR site identification:

5) Are there any existing easements over the premises?
Note: Easement uses vary throughout Queensland and are to be identified correctly and accurately. For further information on easements and how
they may affect the proposed development, see DA Forms Guide.

☒ Yes – All easement locations, types and dimensions are included in plans submitted with this development
       application
☐ No


PART 3 – DEVELOPMENT DETAILS

Section 1 – Aspects of development
 6.1) Provide details about the first development aspect
 a) What is the type of development? (tick only one box)
 ☐ xMaterial change of         ☐ Reconfiguring a lot                       ☐ Operational work                   ☒ Building work
    use
 b) What is the approval type? (tick only one box)
 ☒ Development permit                 ☐ Preliminary approval               ☐ Preliminary approval that includes a variation approval
 c) What is the level of assessment?
 ☒ Code assessment                    ☐ Impact assessment (requires public notification)
 d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
    lots):

 New Dwelling and Garage
 e) Relevant plans
 Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms guide:
       Relevant plans.

 ☒ Relevant plans of the proposed development are attached to the development application
 6.2) Provide details about the second development aspect
 a) What is the type of development? (tick only one box)
 ☐ Material change of use             ☐ Reconfiguring a lot                ☐ Operational work                   ☐ Building work
 b) What is the approval type? (tick only one box)
 ☐ Development permit                 ☐ Preliminary approval               ☐ Preliminary approval that includes a variation approval
 c) What is the level of assessment?
 ☐ Code assessment                    ☐ Impact assessment (requires public notification)
 d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
 lots):



 e) Relevant plans


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                                                                                                       DA Form 1 – Development application details
                                                                                                                    Version 1.2— 7 February 2020