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Operational Works Application OPW19/0168 - DA Form 1 - Owners Consent - 3 Mitti St
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) [OCR of page images] 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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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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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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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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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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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:
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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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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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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.
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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
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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?
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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
Page ! 10
DA Form 1 – Development Application details
Version 1.1— 22 JUNE 2018
[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