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Operational Works Application OPW19/0168 - DA Form 1 - Owners Consent - 3 Mitti St

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Subject: Application 3 Mitti St, Lion Wolf Designs - Driveway Crossover
From: Caroline Gibson
Date: 2019-08-01T01:45:30+00:00
To: Ben Armsstone, Mailbox Council Mail

To Whom it may concern,

Please find attached the appropriate forms for application of Operational works for a new driveway council-cross over at 3 Mitti St, Noosa Heads.
Please let us know if there are any issues with the application as works are time sensitive.
Thanks

[cid:[email protected]]

[Attachment: Mitti St Driveway.pdf]
             DA Form 1 – Development application details
             Approved form (version 1.1 effective 22 JUNE 2018) made under section 282 of the Planning Act
             2016.

             This form must be used to make a development application involving code assessment or impact
             assessment, except when applying for development involving building work.
             For a development application involving building work only, use DA Form 2 – Building work details.
             For a development application involving building work associated with any other type of assessable
             development (i.e. material change of use, operational work or reconfiguring a lot), use this form
             (DA Form 1) and parts 4 to 6 of DA Form 2 – Building work details.
             Unless stated otherwise, all parts of this form must be completed in full and all required supporting
             information must accompany the development application.
             One or more additional pages may be attached as a schedule to this development application if there is
             insufficient space on the form to include all the necessary information.

This form and any other form relevant to the development application must be used to make a development
application relating to strategic port land and Brisbane core port land under the Transport Infrastructure Act 1994, and
airport land under the Airport Assets (Restructuring and Disposal) Act 2008. For the purpose of assessing a
development application relating to strategic port land and Brisbane core port land, any reference to a planning
scheme is taken to mean a land use plan for the strategic port land, Brisbane port land use plan for Brisbane core
port land, or a land use plan for airport land.

             Note:   All terms used in this form have the meaning given under the Planning Act 2016, the Planning Regulation 2017, or the
             Development Assessment Rules (DA Rules).


             PART 1 – APPLICANT DETAILS
               1) Applicant details
               Applicant name(s) (individual or company full name)       Ben Johnstone
               Contact name (only applicable for companies)

               Postal address (P.O. Box or street address)               116 Outlook Drive
               Suburb                                                    Tewantin
               State                                                     QLD
               Postcode                                                  4565
               Country                                                   Australia
               Contact number                                            417145853

               Email address (non-mandatory)                             [email protected]
               Mobile number (non-mandatory)                             417145853
               Fax number (non-mandatory)
               Applicant’s reference number(s) (if applicable)


               2) Owner’s consent

               2.1) Is written consent of the owner required for this development application?
               Yes – the written consent of the owner(s) is attached to this development application
               No – proceed to 3)


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DA Form 1 — Development application details
Approved form (version 1.1 effective 22 JUNE 2018) made under section 282 of the Planning Act
2016.

This form must be used to make a development application involving code assessment or impact
assessment, except when applying for development involving building work.
For a development application involving building work only, use DA Form 2 — Building work details.

For a development application involving building work associated with any other type of assessable
development (i.e. material change of use, operational work or reconfiguring a lot), use this form
(DA Form 1) and parts 4 to 6 of DA Form 2 — Building work details.

Unless stated otherwise, all parts of this form must be completed in full and all required supporting
information must accompany the development application.

One or more additional pages may be attached as a schedule to this development application if there is
insufficient space on the form to include all the necessary information.

 

This form and any other form relevant to the development application must be used to make a development

application relating to strategic port land and Brisbane core port land under the Transport Infrastructure Act 1994, and

airport land under the Airport Assets (Restructuring and Disposal) Act 2008. For the purpose of assessing a

development application relating to strategic port land and Brisbane core port land, any reference to a planning
scheme is taken to mean a land use plan for the strategic port land, Brisbane port land use plan for Brisbane core

port land, or a land use plan for airport land.

 

 

 

Note: All terms used in this form have the meaning given under the Planning Act 2016, the Planning Regulation 2017, or the
Development Assessment Rules (DA Rules).

PART 1 —APPLICANT DETAILS

1) Applicant details

 

 

 

 

 

 

 

 

 

 

 

 

Applicant name(s) (individual or company full name) | Ben Johnstone
Contact name (only applicable for companies)

Postal address (P.O. Box or street address) 116 Outlook Drive
Suburb Tewantin

State QLD

Postcode 4565

Country Australia

Contact number 417145853
Email address (non-mandatory) [email protected]
Mobile number (non-mandatory) 417145853

Fax number (non-mandatory)

Applicant's reference number(s) (if applicable)

 

 

 

2) Owner’s consent

2.1) Is written consent of the owner required for this development application?

 

Yes — the written consent of the owner(s) is attached to this development application
No — proceed to 3)

 

 

 

   

Queensland

CaP) Government

 

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Section 2

Section 3

PART 2 – LOCATION DETAILS

3) Location of the premises (complete 3.1) or 3.2), and 3.3) as applicable)
Note: Provide details below and attach a site plan for any or all premises part of the development application. For further
information, see DA Forms Guide: Relevant plans.

3.1) Street address and lot on plan

Street address AND lot on plan (all lots must be listed), or
Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for
development in water but adjoining or adjacent to land e.g. jetty, pontoon; all lots must be listed).

        Unit No. Street No.            Street Name and Type                                   Suburb
                      3                Mitti St                                               Noosa Heads
 a)     Postcod Lot No.                Plan Type and Number (e.g. RP, SP)                     Local Government Area(s)
        e
        4567          4                                                                       Noosa Council
        Unit No. Street No.            Street Name and Type                                   Suburb


 b)     Postcod Lot No.                Plan Type and Number (e.g. RP, SP)                     Local Government Area(s)
        e


3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or
adjacent to land e.g. channel dredging in Moreton Bay)
Note: Place each set of coordinates in a separate row. Only one set of coordinates is required for this part.

Coordinates of premises by longitude and latitude

Longitude(s)                    Latitude(s)                  Datum                         Local Government Area(s) (if
                                                                                           applicable)

                                                              WGS84
                                                              GDA94
                                                              Other:
Coordinates of premises by easting and northing
Easting(s)                Northing(s)         Zone           Datum                         Local Government Area(s) (if
                                              Ref.                                         applicable)

                                               54             WGS84
                                               55             GDA94
                                               56             Other:
3.3) Additional premises
 Additional premises are relevant to this development application and their details have been attached
in a schedule to this application
 Not required


4) Identify any of the following that apply to the premises and provide any relevant details
In or adjacent to a water body or watercourse or in or above an aquifer

Name of water body, watercourse or aquifer:
On strategic port land under the Transport Infrastructure Act 1994



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                                                                                                       Version 1.1— 22 JUNE 2018


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PART 2 — LOCATION DETAILS

3) Location of the premises (complete 3.1) or 3.2), and 3.3) as applicable)
Note: Provide details below and attach a site plan for any or all premises part of the development application. For further

information, see DA Forms Guide: Relevant plans.
3.1) Street address and lot on plan

 

Street address AND lot on plan (all lots must be listed), Or

Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for
development in water but adjoining or adjacent to land e.g. jetty, pontoon; all lots must be listed).

 

 

 

 

 

 

 

 

 

 

 

 

 

Unit No. | Street No. | Street Name and Type Suburb
3 Mitti St Noosa Heads
@) | Postcod | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
e
4567 4 Noosa Council
Unit No. | Street No. | Street Name and Type Suburb
b) | Postcod Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
e
3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or
adjacent to land e.g. channel dredging in Moreton Bay)
Note: Place each set of coordinates in a separate row. Only one set of coordinates is required for this part.
Coordinates of premises by longitude and latitude

 

 

 

 

Longitude(s) Latitude(s) Datum Local Government Area(s) (if
applicable)
WGS84
GDA94
Other:

 

Coordinates of premises by easting and northing

 

 

 

 

Easting(s) Northing(s) Zone Datum Local Government Area(s) (if
Ref. applicable)
54 WGS84
55 GDA94
56 Other:

3.3) Additional premises

 

Additional premises are relevant to this development application and their details have been attached
in a schedule to this application
Not required

 

4) Identify any of the following that apply to the premises and provide any relevant details

 

In or adjacent to a water body or watercourse or in or above an aquifer

 

 

Name of water body, watercourse or aquifer:

 

On strategic port land under the Transport Infrastructure Act 1994

 

 

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DA Form 1 — Development Application details
Version 1.1— 22 JUNE 2018

Section 4

Section 5

Lot on plan description of strategic port land:
Name of port authority for the lot:
 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)

 Material change of use                 Reconfiguring a lot               Operational work YES               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
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)



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Lot on plan description of strategic port land:

 

Name of port authority for the lot:

 

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)

Material change of use Reconfiguring a lot Operational work YES 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
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)

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DA Form 1 — Development Application details
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Section 6

Section 7

  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
 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


 6.3) Additional aspects of development
  Additional aspects of development are relevant to this development application and the details for
 these aspects that would be required under Part 3 Section 1 of this form have been attached to this
 development application
  Not required


Section 2 – Further development details
 7) Does the proposed development application involve any of the following?

 Material change of use               Yes – complete division 1 if assessable against a local planning
                                     instrument
 Reconfiguring a lot                 Yes – complete division 2
 Operational work                    Yes – complete division 3
 Building work                       Yes – complete DA Form 2 – Building work details

Division 1 – Material change of use
Note: This division is only required to be completed if any part of the development application involves a material change of use
assessable against a local planning instrument.

 8.1) Describe the proposed material change of use

 Provide a general description of               Provide the planning scheme                    Number of                Gross
 the proposed use                               definition (include each definition in a       dwelling units (if       floor area
                                                new row)                                       applicable)              (m2)
                                                                                                                        (if
                                                                                                                        applicable)




 8.2) Does the proposed use involve the use of existing buildings on the premises?

  Yes
  No


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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
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

 

 

6.3) Additional aspects of development

 

Additional aspects of development are relevant to this development application and the details for
these aspects that would be required under Part 3 Section 1 of this form have been attached to this
development application

Not required

Section 2 — Further development details
7) Does the proposed development application involve any of the following?

 

 

 

 

 

 

Material change of use Yes — complete division 1 if assessable against a local planning
instrument

Reconfiguring a lot Yes — complete division 2

Operational work Yes — complete division 3

Building work Yes — complete DA Form 2 — Building work details

 

Division 1 — Material change of use
Note: This division is only required to be completed if any part of the development application involves a material change of use
assessable against a local planning instrument.

    

8.1) Describe the proposed material change of use

Provide a general description of Provide the planning scheme Number of Gross
the proposed use definition (include each definition in a dwelling units (if floor area
new row) applicable) (m2)
(if
applicable)

 

 

 

 

 

 

8.2) Does the proposed use involve the use of existing buildings on the premises?

 

Yes

 

No

 

 

 

 

 

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DA Form 1 — Development Application details
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Section 8

Section 9

Division 2 – Reconfiguring a lot
Note: This division is only required to be completed if any part of the development application involves reconfiguring a lot.

 9.1) What is the total number of existing lots making up the premises?


 9.2) What is the nature of the lot reconfiguration? (tick all applicable boxes)

  Subdivision (complete 10))                                   Dividing land into parts by agreement (complete 11))
  Boundary realignment (complete 12))                          Creating or changing an easement giving access to a
                                                                 lot from a construction road (complete 13))


 10) Subdivision
 10.1) For this development, how many lots are being created and what is the intended use of those
 lots:
 Intended use of lots created Residential                     Commercial           Industrial            Other, please specify:


 Number of lots created
 10.2) Will the subdivision be staged?
  Yes – provide additional details below
  No

 How many stages will the works include?
 What stage(s) will this development
 application apply to?


 11) Dividing land into parts by agreement – how many parts are being created and what is the intended
 use of the parts?

 Intended use of parts                 Residential            Commercial           Industrial            Other, please specify:
 created

 Number of parts created


 12) Boundary realignment
 12.1) What are the current and proposed areas for each lot comprising the premises?

                              Current lot                                                        Proposed lot
 Lot on plan description                Area (m2)                           Lot on plan description             Area (m2)




 12.2) What is the reason for the boundary realignment?




 13) What are the dimensions and nature of any existing easements being changed and/or any
 proposed easement? (attach schedule if there are more than two easements)




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Division 2 — Reconfiguring a lot
Note: This division is only required to be completed if any part of the development application involves reconfiguring a lot.

9.1) What is the total number of existing lots making up the premises?

9.2) What is the nature of the lot reconfiguration? (tick all applicable boxes)

Subdivision (complete 10)) Dividing land into parts by agreement (complete 11))

 

 

Boundary realignment (complete 12)) Creating or changing an easement giving access to a
lot from a construction road (complete 13))

 

 

 

 

10) Subdivision

10.1) For this development, how many lots are being created and what is the intended use of those
ol cS

 

Intended use of lots created | Residential Commercial Industrial Other, please specify:

 

 

 

Number of lots created

10.2) Will the subdivision be staged?

 

Yes — provide additional details below
No

 

How many stages will the works include?

 

What stage(s) will this development
application apply to?

 

11) Dividing land into parts by agreement — how many parts are being created and what is the intended
use of the parts?

 

Intended use of parts Residential Commercial Industrial Other, please specify:
created

 

 

Number of parts created

 

 

 

 

 

12) Boundary realignment
12.1) What are the current and proposed areas for each lot comprising the premises?

 

Current lot Proposed lot

 

Lot on plan description Area (m2) Lot on plan description Area (m2)

 

 

 

 

 

 

12.2) What is the reason for the boundary realignment?

 

 

 

13) What are the dimensions and nature of any existing easements being changed and/or any
proposed easement? (attach schedule if there are more than two easements)

 

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DA Form 1 — Development Application details
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Section 10

Section 11

 Existing or             Width         Length          Purpose of the easement? (e.g.               Identify the land/lot(s)
 proposed?               (m)           (m)             pedestrian access)                           benefitted by the
                                                                                                    easement




Division 3 – Operational work
Note: This division is only required to be completed if any part of the development application involves operational work.

 14.1) What is the nature of the operational work?
  Road work                                         Stormwater                         Water infrastructure
  Drainage work                                     Earthworks                         Sewage infrastructure
  Landscaping                                       Signage                            Clearing vegetation

  Other – please specify:              Driveway Crossover


 14.2) Is the operational work necessary to facilitate the creation of new lots? (e.g. subdivision)

  Yes – specify number of new lots:
  No -                                                          N/A
 14.3) What is the monetary value of the proposed operational work? (include GST, materials and labour)

 5000


PART 4 – ASSESSMENT MANAGER DETAILS

 15) Identify the assessment manager(s) who will be assessing this development application
 Noosa Council

 16) Has the local government agreed to apply a superseded planning scheme for this development
 application?
 Yes – a copy of the decision notice is attached to this development application
 Local government is taken to have agreed to the superseded planning scheme request – relevant
 documents attached
 No - NO




PART 5 – REFERRAL DETAILS

 17) Do any aspects of the proposed development require referral for any referral requirements?
 Note: A development application will require referral if prescribed by the Planning Regulation 2017.

 No, there are no referral requirements relevant to any development aspects identified in this
 development application – proceed to Part 6
 Matters requiring referral to the Chief Executive of the Planning Regulation 2017:




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Existing or Width Length Purpose of the easement? (e.g. Identify the land/lot(s)
proposed? (m) (m) pedestrian access) benefitted by the
easement

 

 

 

 

 

 

 

 

 

Division 3 — Operational work
Note: This division is only required to be completed if any part of the development application involves operational work.

 

14.1) What is the nature of the operational work?

 

Road work Stormwater Water infrastructure
Drainage work Earthworks Sewage infrastructure
Landscaping Signage Clearing vegetation
Other — please specify: | Driveway Crossover

    
  
 
 

14.2) Is the operational work necessary to facilitate the creation of new lots? (e.g. subdivision)

Yes — specify number of new lots:

 

No - N/A

14.3) What is the monetary value of the proposed operational work? (include GST, materials and labour)

5000

 

 

 

PART 4 —-ASSESSMENT MANAGER DETAILS

15) Identify the assessment manager(s) who will be assessing this development application

Noosa Council

16) Has the local government agreed to apply a superseded planning scheme for this development
application?

 

Yes — a copy of the decision notice is attached to this development application

Local government is taken to have agreed to the superseded planning scheme request — relevant
documents attached

No - NO

 

PART 5 — REFERRAL DETAILS

17) Do any aspects of the proposed development require referral for any referral requirements?

 

Note: A development application will require referral if prescribed by the Planning Regulation 2017.

No, there are no referral requirements relevant to any development aspects identified in this
development application — proceed to Part 6

 

Matters requiring referral to the Chief Executive of the Planning Regulation 2017:

Page 6
DA Form 1 — Development Application details
Version 1.1— 22 JUNE 2018

Section 12

Section 13

Clearing native vegetation
Contaminated land (unexploded ordnance)
Environmentally relevant activities (ERA) (only if the ERA have not been devolved to a local government)
Fisheries – aquaculture
Fisheries – declared fish habitat area
Fisheries – marine plants
Fisheries – waterway barrier works
Hazardous chemical facilities
Queensland heritage place (on or near a Queensland heritage place)
Infrastructure – designated premises
Infrastructure – state transport infrastructure
Infrastructure – state transport corridors and future state transport corridors
Infrastructure – state-controlled transport tunnels and future state-controlled transport tunnels
Infrastructure – near a state-controlled road intersection
On Brisbane core port land near a State transport corridor or future State transport corridor
On Brisbane core port land – ERA
On Brisbane core port land – tidal works or work in a coastal management district
On Brisbane core port land – hazardous chemical facility
On Brisbane core port land – taking or interfering with water
On Brisbane core port land – referable dams
On Brisbane core port land - fisheries
Land within Port of Brisbane’s port limits
SEQ development area
SEQ regional landscape and rural production area or SEQ rural living area – tourist activity or sport
and recreation activity
SEQ regional landscape and rural production area or SEQ rural living area – community activity
SEQ regional landscape and rural production area or SEQ rural living area – indoor recreation
SEQ regional landscape and rural production area or SEQ rural living area – urban activity
SEQ regional landscape and rural production area or SEQ rural living area – combined use
Tidal works or works in a coastal management district
Reconfiguring a lot in a coastal management district or for a canal
Erosion prone area in a coastal management district
Urban design
Water-related development – taking or interfering with water
Water-related development – removing quarry material (from a watercourse or lake)
Water-related development – referable dams
Water-related development – construction of new levees or modification of existing levees (category 3
levees only)
Wetland protection area
Matters requiring referral to the local government:
Airport land
Environmentally relevant activities (ERA) (only if the ERA have been devolved to local government)
Local heritage places

Matters requiring referral to the chief executive of the distribution entity or transmission entity:
Electricity infrastructure
Matters requiring referral to:
• The Chief executive of the holder of the licence, if not an individual
• The holder of the licence, if the holder of the licence is an individual
 Oil and gas infrastructure
Matters requiring referral to the Brisbane City Council:
Brisbane core port land


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                                                                                         Version 1.1— 22 JUNE 2018


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Clearing native vegetation

Contaminated land (unexploded ordnance)

Environmentally relevant activities (ERA) (only if the ERA have not been devolved to a local government)
Fisheries — aquaculture

Fisheries — declared fish habitat area

Fisheries — marine plants

Fisheries — waterway barrier works

Hazardous chemical facilities

Queensland heritage place (on or near a Queensland heritage place)

Infrastructure — designated premises

Infrastructure — state transport infrastructure

Infrastructure — state transport corridors and future state transport corridors

Infrastructure — state-controlled transport tunnels and future state-controlled transport tunnels
Infrastructure — near a state-controlled road intersection

On Brisbane core port land near a State transport corridor or future State transport corridor
On Brisbane core port land - ERA

On Brisbane core port land — tidal works or work in a coastal management district

On Brisbane core port land — hazardous chemical facility

On Brisbane core port land — taking or interfering with water

On Brisbane core port land — referable dams

On Brisbane core port land - fisheries

Land within Port of Brisbane’s port limits

SEQ development area

SEQ regional landscape and rural production area or SEQ rural living area — tourist activity or sport
and recreation activity

SEQ regional landscape and rural production area or SEQ rural living area — community activity
SEQ regional landscape and rural production area or SEQ rural living area — indoor recreation
SEQ regional landscape and rural production area or SEQ rural living area — urban activity
SEQ regional landscape and rural production area or SEQ rural living area — combined use
Tidal works or works in a coastal management district

Reconfiguring a lot in a coastal management district or for a canal

Erosion prone area in a coastal management district

Urban design

Water-related development — taking or interfering with water

Water-related development — removing quarry material (from a watercourse or lake)

Water-related development — referable dams

Water-related development — construction of new levees or modification of existing levees (category 3
levees only)

Wetland protection area

 

Matters requiring referral to the local government:

Airport land
Environmentally relevant activities (ERA) (only if the ERA have been devolved to local government)
Local heritage places

 

Matters requiring referral to the chief executive of the distribution entity or transmission entity:
Electricity infrastructure

 

Matters requiring referral to:

°* The Chief executive of the holder of the licence, if not an individual
¢ The holder of the licence, if the holder of the licence is an individual
Oil and gas infrastructure

 

 

Matters requiring referral to the Brisbane City Council:
Brisbane core port land

 

 

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Section 14

Section 15

Matters requiring referral to the Minister under the Transport Infrastructure Act 1994:
Brisbane core port land (inconsistent with Brisbane port LUP for transport reasons)
Strategic port land
Matters requiring referral to the relevant port operator:
Land within Port of Brisbane’s port limits (below high-water mark)
Matters requiring referral to the Chief Executive of the relevant port authority:
Land within limits of another port (below high-water mark)

Matters requiring referral to the Gold Coast Waterways Authority:
Tidal works, or work in a coastal management district in Gold Coast waters
Matters requiring referral to the Queensland Fire and Emergency Service:
Tidal works marina (more than six vessel berths)


18) Has any referral agency provided a referral response for this development application?
Yes – referral response(s) received and listed below are attached to this development application
No -NO
Referral requirement                           Referral agency                            Date of referral response
N/A


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

I agree to receive an information request if determined necessary for this development application
I 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
• 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.




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                                                                                               Version 1.1— 22 JUNE 2018


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Matters requiring referral to the Minister under the Transport Infrastructure Act 1994:
Brisbane core port land (inconsistent with Brisbane port LUP for transport reasons)
Strategic port land

 

Matters requiring referral to the relevant port operator:
Land within Port of Brisbane’s port limits (below high-water mark)

 

Matters requiring referral to the Chief Executive of the relevant port authority:
Land within limits of another port (below high-water mark)

 

Matters requiring referral to the Gold Coast Waterways Authority:
Tidal works, or work in a coastal management district in Gold Coast waters

 

Matters requiring referral to the Queensland Fire and Emergency Service:

 

Tidal works marina (more than six vessel berths)

 

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

 

Yes — referral response(s) received and listed below are attached to this development application
No -NO

 

Referral requirement Referral agency Date of referral response
N/A

 

 

 

 

 

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 ina
schedule to this development application (if applicable).

 

 

 

 

PART 6 — INFORMATION REQUEST

19) Information request under Part 3 of the DA Rules

 

| agree to receive an information request if determined necessary for this development application
| 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

* 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.

 

Page 8
DA Form 1 — Development Application details
Version 1.1— 22 JUNE 2018

Section 16

Section 17

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 -NO
List of approval/                     Reference number                 Date                              Assessment
development application                                                                                  manager
references

Approval
Development application
Approval
Development application


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

 Yes – a copy of the receipted QLeave form is attached to this development application
 No – I, the applicant will provide evidence that the portable long service leave levy has been paid
before the assessment manager decides the development application. I acknowledge that the
assessment manager may give a development approval only if I provide evidence that the portable
long service leave levy has been paid
 Not applicable (e.g. building and construction work is less than $150,000 excluding GST)
Amount paid                          Date paid (dd/mm/yy)                     QLeave levy number
$N/A                                 N/A                                      N/A


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 -N/A


23) Further legislative requirements
Environmentally relevant activities
23.1) Is this development application also taken to be an application for an environmental authority for
an Environmentally Relevant Activity (ERA) under section 115 of the Environmental Protection Act
1994?
Yes – the required attachment (form ESR/2015/1791) for an application for an environmental authority
accompanies this development application, and details are provided in the table below
No
Note: Application for an environmental authority can be found by searching “ESR/2015/1791” as a search term at
www.qld.gov.au. An ERA requires an environmental authority to operate. See www.business.qld.gov.au for further information.

Proposed ERA number:                 N/A                             Proposed ERA threshold: N/A

Proposed ERA name:                   N/A
        Multiple ERAs are applicable to this development application and the details have been attached
        in a schedule to this development application.
Hazardous chemical facilities
23.2) Is this development application for a hazardous chemical facility?



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                                                                                    DA Form 1 – Development Application details
                                                                                                  Version 1.1— 22 JUNE 2018


[OCR of page images]
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 -NO

 

 

List of approval/ Reference number Date Assessment
development application manager
references

Approval

Development application

 

Approval
Development application

 

 

 

 

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

 

building work or operational work)

Yes — a copy of the receipted QLeave form is attached to this development application

No — 1, 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 development approval only if | provide evidence that the portable
long service leave levy has been paid

Not applicable (e.g. building and construction work is less than $150,000 excluding GST)

 

Amount paid Date paid (dd/mm/yy) QLeave levy number
$N/A N/A N/A

 

 

 

 

 

 

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 -N/A

 

23) Further legislative requirements

Environmentally relevant a CS

23.1) Is this development application also taken to be an application for an environmental authority for
an Environmentally Relevant Activity (ERA) under section 115 of the Environmental Protection Act
1994?

 

Yes — the required attachment (form ESR/2015/1791) for an application for an environmental authority
accompanies this development application, and details are provided in the table below
No

Note: Application for an environmental authority can be found by searching “ESR/2015/1791” as a search term at
www.qld.gov.au. An ERA requires an environmental authority to operate. See www.business.qid.gov.au for further information.

Proposed ERA number: N/A Proposed ERA threshold: | N/A

 

 

 

 

 

Proposed ERA name: N/A

 

Multiple ERAs are applicable to this development application and the details have been attached
in a schedule to this development application.

 

 

Hazardous chemical facilities

 

23.2) Is this development application for a hazardous chemical facility?

Page 9
DA Form 1 — Development Application details
Version 1.1— 22 JUNE 2018

Section 18

Section 19

Yes – Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this
development application
No
Note: See www.business.qld.gov.au for further information about hazardous chemical notifications.

Clearing native vegetation

23.3) Does this development application involve clearing native vegetation that requires written
confirmation that the chief executive of the Vegetation Management Act 1999 is satisfied the clearing is
for a relevant purpose under section 22A of the Vegetation Management Act 1999?
Yes – this development application includes written confirmation from the chief executive of the
Vegetation Management Act 1999 (s22A determination)
No
Note: 1. Where a development application for operational work or material change of use requires a s22A determination and
this is not included, the development application is prohibited development.
2. See https://www.qld.gov.au/environment/land/vegetation/applying for further information on how to obtain a s22A
determination.

Environmental offsets
23.4) Is this development application taken to be a prescribed activity that may have a significant
residual impact on a prescribed environmental matter under the Environmental Offsets Act 2014?
Yes – I acknowledge that an environmental offset must be provided for any prescribed activity
assessed as having a significant residual impact on a prescribed environmental matter
No
Note: The environmental offset section of the Queensland Government’s website can be accessed at www.qld.gov.au for further
information on environmental offsets.

Koala conservation
23.5) Does this development application involve a material change of use, reconfiguring a lot or
operational work within an assessable development area under Schedule 10, Part 10 of the Planning
Regulation 2017?
Yes
No
Note: See guidance materials at www.des.qld.gov.au for further information.

Water resources
23.6) Does this development application involve taking or interfering with underground water
through an artesian or subartesian bore, taking or interfering with water in a watercourse, lake
or spring, or taking overland flow water under the Water Act 2000?
 Yes – the relevant template is completed and attached to this development application and I
acknowledge that a relevant authorisation or licence under the Water Act 2000 may be required prior to
commencing development
 No
Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.qld.gov.au for further information.
DA templates are available from https://planning.dsdmip.qld.gov.au/. If the development application involves:
• Taking or interfering with underground water through an artesian or subartesian bore: complete DA Form 1 Template 1
• Taking or interfering with water in a watercourse, lake or spring: complete DA Form1 Template 2
• Taking overland flow water: complete DA Form 1 Template 3.

Waterway barrier works
23.7) Does this application involve waterway barrier works?
Yes – the relevant template is completed and attached to this development application
No
DA templates are available from https://planning.dsdmip.qld.gov.au/. For a development application involving waterway barrier
works, complete DA Form 1 Template 4.

Marine activities



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[OCR of page images]
Yes — Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this
development application

No
Note: See www.business.qld.gov.au for further information about hazardous chemical notifications.

Clearing native vegetation

23.3) Does this development application involve clearing native vegetation that requires written

confirmation that the chief executive of the Vegetation Management Act 1999 is satisfied the clearing is
for a relevant purpose under section 22A of the Vegetation Management Act 1999?

 

Yes — this development application includes written confirmation from the chief executive of the
Vegetation Management Act 1999 (s22A determination)
No

Note: 1. Where a development application for operational work or material change of use requires a s22A determination and
this is not included, the development application is prohibited development.

2. See https://www.gid.gov.au/environment/land/vegetation/applying for further information on how to obtain a s22A
determination.

Environmental offsets

23.4) Is this development application taken to be a prescribed activity that may have a significant

 

Yes — | acknowledge that an environmental offset must be provided for any prescribed activity
assessed as having a significant residual impact on a prescribed environmental matter
No

Note: The environmental offset section of the Queensland Government's website can be accessed at www.qld.gov.au for further
information on environmental offsets.
Koala conservation

23.5) Does this development application involve a material change of use, reconfiguring a lot or
operational work within an assessable development area under Schedule 10, Part 10 of the Planning
Regulation 2017?

Yes

No
Note: See guidance materials at www.des.qid.gov.au for further information.

 

Water resources

23.6) Does this development application involve taking or interfering with underground water

through an artesian or subartesian bore, taking or interfering with water in a watercourse, lake
or spring, or taking overland flow water under the Water Act 2000?

 

Yes — the relevant template is completed and attached to this development application and |
acknowledge that a relevant authorisation or licence under the Water Act 2000 may be required prior to
commencing development
No
Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.qid.gov.au for further information.
DA templates are available from https://planning.dsdmip.qld.gov.au/. If the development application involves:
* Taking or interfering with underground water through an artesian or subartesian bore: complete DA Form 1 Template 1
* Taking or interfering with water in a watercourse, lake or spring: complete DA Form1 Template 2
* Taking overland flow water: complete DA Form 1 Template 3.

Waterway barrier works

23.7) Does this application involve waterway barrier works?

 

Yes — the relevant template is completed and attached to this development application
No

DA templates are available from https://planning.dsdmip.qld.gov.au/. For a development application involving waterway barrier
works, complete DA Form 1 Template 4.

   

Page 10
DA Form 1 — Development Application details
Version 1.1— 22 JUNE 2018

Section 20

Section 21

23.8) Does this development application involve aquaculture, works within a declared fish habitat
area or removal, disturbance or destruction of marine plants?
 Yes – an associated resource allocation authority is attached to this development application, if
required under the Fisheries Act 1994
 No
Note: See guidance materials at www.daf.qld.gov.au for further information.

Quarry materials from a watercourse or lake
23.9) Does this development application involve the removal of quarry materials from a watercourse
or lake under the Water Act 2000?
Yes – I acknowledge that a quarry material allocation notice must be obtained prior to commencing
development
No
Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.qld.gov.au and www.business.qld.gov.au
for further information.

Quarry materials from land under tidal waters
23.10) Does this development application involve the removal of quarry materials from land under
tidal water under the Coastal Protection and Management Act 1995?
Yes – I acknowledge that a quarry material allocation notice must be obtained prior to commencing
development
No
Note: Contact the Department of Environment and Science at www.des.qld.gov.au for further information.

Referable dams
23.11) Does this development application involve a referable dam required to be failure impact
assessed under section 343 of the Water Supply (Safety and Reliability) Act 2008 (the Water Supply
Act)?
Yes – the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the
Water Supply Act is attached to this development application
No
Note: See guidance materials at www.dnrme.qld.gov.au for further information.

Tidal work or development within a coastal management district
23.12) Does this development application involve tidal work or development in a coastal
management district?
Yes – the following is included with this development application:
     Evidence the proposal meets the code for assessable development that is prescribed tidal work
      (only required if application involves prescribed tidal work)
       A certificate of title
No
Note: See guidance materials at www.des.qld.gov.au for further information.

Queensland and local heritage places
23.13) Does this development application propose development on or adjoining a place entered in the
Queensland heritage register or on a place entered in a local government’s Local Heritage
Register?
Yes – details of the heritage place are provided in the table below
No
Note: See guidance materials at www.des.qld.gov.au for information requirements regarding development of Queensland
heritage places.

Name of the heritage place:                                             Place ID:
Brothels


                                                                                                                     Page !11
                                                                                    DA Form 1 – Development Application details
                                                                                                  Version 1.1— 22 JUNE 2018


[OCR of page images]
23.8) Does this development application involve aquaculture, works within a declared fish habitat

area or removal, disturbance or destruction of marine plants?

 

Yes — an associated resource allocation authority is attached to this development application, if
required under the Fisheries Act 1994

No

Note: See guidance materials at www.daf qid.gov.au for further information.

 
  

23.9) Does this development application involve the removal of quarry materials from a watercourse
or lake under the Water Act 2000?

Yes — | acknowledge that a quarry material allocation notice must be obtained prior to commencing
development

No
Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.qid.gov.au and www.business.qld.gov.au
for further information.

Quarry materials from land under tidal waters

23.10) Does this development application involve the removal of quarry materials from land under

tidal water under the Coastal Protection and Management Act 1995?

 

Yes — | acknowledge that a quarry material allocation notice must be obtained prior to commencing
development
No

Note: Contact the Department of Environment and Science at www.des.qld.gov.au for further information.

Referable dams

23.11) Does this development application involve a referable dam required to be failure impact

assessed under section 343 of the Water Supply (Safety and Reliability) Act 2008 (the Water Supply
Act)?

 

Yes — the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the
Water Supply Act is attached to this development application

No

Note: See guidance materials at www.dnrme.qld.gov.au for further information.

23.12) Does this development application involve tidal work or development in a coastal
management district?

 

Yes — the following is included with this development application:
Evidence the proposal meets the code for assessable development that is prescribed tidal work
(only required if application involves prescribed tidal work)
A certificate of title
No
Note: See guidance materials at www.des.qid.gov.au for further information.

ueensland and local hi IE-Tetst=9

23.13) Does this development application propose development on or adjoining a place entered in the
Queensland heritage register or on a place entered in a local government's Local Heritage
Register?

 

Yes — details of the heritage place are provided in the table below

No
Note: See guidance materials at www.des.qid.gov.au for information requirements regarding development of Queensland
heritage places.

Name of the heritage place: Place ID:

 

Brothels

Page 11
DA Form 1 — Development Application details
Version 1.1— 22 JUNE 2018

Section 22

Section 23

23.14) Does this development application involve a material change of use for a brothel?
Yes – this development application demonstrates how the proposal meets the code for a development
application for a brothel under Schedule 3 of the Prostitution Regulation 2014
No
Decision under section 62 of the Transport Infrastructure Act 1994

23.15) Does this development application involve new or changed access to a state-controlled road?
 Yes - this application will be taken to be an application for a decision under section 62 of the Transport
Infrastructure Act 1994 (subject to the conditions in section 75 of the Transport Infrastructure Act 1994
being satisfied)
 No




PART 8 – CHECKLIST AND APPLICANT DECLARATION

24) Development application checklist

I have identified the assessment manager in question 15 and all relevant referral
requirement(s) in question 17                                                                          Yes
Note: See the Planning Regulation 2017 for referral requirements

If building work is associated with the proposed development, Parts 4 to 6 of DA
Form 2 – Building work details have been completed and attached to this
development application                                                                                Not applicable - N/A

Supporting information addressing any applicable assessment benchmarks is
with development application
Note: This is a mandatory requirement and includes any relevant templates under question 23, a         Yes
planning report and any technical reports required by the relevant categorising instruments (e.g.
local government planning schemes, State Planning Policy, State Development Assessment
Provisions). For further information, see DA Forms Guide: Planning Report Template.

Relevant plans of the development are attached to this development application
Note: Relevant plans are required to be submitted for all aspects of this development application.     Yes
For further information, see DA Forms Guide: Relevant plans.

The portable long service leave levy for QLeave has been paid, or will be paid                         Yes
before a development permit is issued (see 21))                                                        Not applicable


25) Applicant declaration
 By making this development application, I declare that all information in this development application is
true and correct
 Where an email address is provided in Part 1 of this form, I consent to receive future electronic
communications from the assessment manager and any referral agency for the development
application where written information is required or permitted pursuant to sections 11 and 12 of the
Electronic Transactions Act 2001
Note: It is unlawful to intentionally provide false or misleading information.




                                                                                                                       Page ! 12
                                                                                      DA Form 1 – Development Application details
                                                                                                    Version 1.1— 22 JUNE 2018


[OCR of page images]
23.14) Does this development application involve a material change of use for a brothel?

Yes — this development application demonstrates how the proposal meets the code for a development
application for a brothel under Schedule 3 of the Prostitution Regulation 2014

No
Decision under section 62 of the Transport Infrastructure Act 1994

23.15) Does this development application involve new or changed access to a state-controlled road?

 

Yes - this application will be taken to be an application for a decision under section 62 of the Transport
Infrastructure Act 1994 (subject to the conditions in section 75 of the Transport Infrastructure Act 1994
being satisfied)

No

 

PART 8 — CHECKLIST AND APPLICANT DECLARATION

24) Development application checklist

 

| have identified the assessment manager in question 15 and all relevant referral
requirement(s) in question 17 Yes
Note: See the Planning Regulation 2017 for referral requirements

 

If building work is associated with the proposed development, Parts 4 to 6 of DA
Form 2 — Building work details have been completed and attached to this

development application Not applicable - N/A

 

Supporting information addressing any applicable assessment benchmarks is

with development application

Note: This is a mandatory requirement and includes any relevant templates under question 23, a Yes
planning report and any technical reports required by the relevant categorising instruments (e.g.

local government planning schemes, State Planning Policy, State Development Assessment

Provisions). For further information, see DA Forms Guide: Planning Report Template.

 

Relevant plans of the development are attached to this development application

Note: Relevant plans are required to be submitted for all aspects of this development application. Yes
For further information, see DA Forms Guide: Relevant plans.

 

The portable long service leave levy for QLeave has been paid, or will be paid Yes
before a development permit is issued (see 21)) Not applicable

 

25) Applicant declaration

 

By making this development application, | declare that all information in this development application is
true and correct

Where an email address is provided in Part 1 of this form, | consent to receive future electronic
communications from the assessment manager and any referral agency for the development
application where written information is required or permitted pursuant to sections 11 and 12 of the
Electronic Transactions Act 2001

Note: It is unlawful to intentionally provide false or misleading information.

 

 

 

Page 12
DA Form 1 — Development Application details
Version 1.1— 22 JUNE 2018

Section 24

Section 25

Privacy – Personal information collected in this form will be used by the assessment manager and/or
chosen assessment manager, any relevant referral agency and/or building certifier (including any
professional advisers which may be engaged by those entities) while processing, assessing and
deciding the development application.
All information relating to this development application may be available for inspection and purchase,
and/or published on the assessment manager’s and/or referral agency’s website.
Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning
Regulation 2017 and the DA Rules except where:
• such disclosure is in accordance with the provisions about public access to documents contained in
     the Planning Act 2016 and the Planning Regulation 2017, and the access rules made under the
     Planning Act 2016 and Planning Regulation 2017; or
• required by other legislation (including the Right to Information Act 2009); or
• otherwise required by law.
This information may be stored in relevant databases. The information collected will be retained as
required by the Public Records Act 2002.


PART 9 – FOR OFFICE USE ONLY

Date received:                              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 if 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




                                                                                                    Page ! 13
                                                                   DA Form 1 – Development Application details
                                                                                 Version 1.1— 22 JUNE 2018


[OCR of page images]
 

Privacy — Personal information collected in this form will be used by the assessment manager and/or
chosen assessment manager, any relevant referral agency and/or building certifier (including any
professional advisers which may be engaged by those entities) while processing, assessing and
deciding the development application.

All information relating to this development application may be available for inspection and purchase,

and/or published on the assessment manager’s and/or referral agency’s website.

Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning

Regulation 2017 and the DA Rules except where:

* such disclosure is in accordance with the provisions about public access to documents contained in
the Planning Act 2016 and the Planning Regulation 2017, and the access rules made under the
Planning Act 2016 and Planning Regulation 2017; or

* required by other legislation (including the Right to Information Act 2009); or

* otherwise required by law.

This information may be stored in relevant databases. The information collected will be retained as

required by the Public Records Act 2002.

 

 

PART 9 — FOR OFFICE USE ONLY

 

 

 

Date received: 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 if 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

 

Page 13
DA Form 1 — Development Application details
Version 1.1— 22 JUNE 2018

Section 26


[Attachment: image1-17.png (image text)]
Queensland
Government

 

Section 27


[Attachment: 2462_001.pdf]
 l, (l1¿lsca Dft¿GtE
                                                                                           Insert full name.l



 as owner of the premises identified as follows



            llnsert sfreef address, lot on plan description or coordinates of the premises the subject of the
                                                                   ¿ts6-}                       application'l
      slg ¡{ltm ,s'rca€Tt Lt              e cove @to


consent to the making of a development application under lhe Planning Act 2016 by:

  Lto¡'t t^tot-F D6slêñ-S                                                         llnsert name of applicant.l



on the premises described above for:


        llnsert details of the proposed development, e.g. material change of use for four storey apartment
                                                                                                  building.l
  UPG¿êæ, ÐAvew*_¡ CeogÍ ovet_




                                                                                     lsignature of owner and
                                                                                       .          date signedl




                                                                                            Applicant template I 0.0
                                                                                           Version 1.0-3 July 2O17


[OCR of page images]
 

 

Individual owner’s consent for making a development application under
the Planning Act 2016

 

 

 

| Meussa DOALEIE
[insert full name.]

 

 

as owner of the premises identified as follows:

 

[insert street address, lot on plan description or coordinates of the premises the subject of the

 

 

5/3 Mim smeeET, LITE COVE QLO 4567 application.
consent to the making of a development application under the Planning Act 2016 by:
Linn Wolf DESIENS [insert name of applicant.]

 

on the premises described above for:

 

[Insert details of the proposed development, e.g. material change of use for four storey apartment
building.]
UPGERCE Déivewan.y CKosfovEed

 

 

[signature of owner and

date signed]

dl tien Derg

 

 

 

Applicant template 10.0
Version 1.0—3 July 2017

The supporting record

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