Development Application for permit to damage vegetation - OPW13/0333

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   12. Is the paymen~ of a,portable long service leave levY’
                                                                                                             a~plic~bl:e to t"i~ application? (R~fer to notes at the end
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   of this form for more information.)                                                                                                          ,
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   o No-go to question 14
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                                                       DYes
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   ~ 3’. H’as .the PQI"\~bJe                ng !?ervJce, eave             ’Ievy:tie ~’ paid_? (~ef r fo not s at the ~l’)d~~f,t~ffi’{Qj~ for llJ.ore~
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   Information,)                                  .                                                 ".’


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   o           No


   o           Yes-complete Table N and submit with this application the yellow local government/private certifier’s copy of the
               receipted QLeave form

  Table N

  Amount paid                              Date paid                  QLeave project number (6digit number starting with A, B, E, Lor P)
                                           (dd/mm/yy)




   14. Has the~local go~~rnment agreed to ~P\ ly a superseded planning scheme to this
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                                                                                                                                                                                                  application under section
   96 of the Sustainable ’Planning.Act 200,9.7                                       I




_,D No
   o           Yes-please provide details below

  Name of local government                                                          Date of written notice given                                           Reference number of written notice given
                                                                                    by local government                                                    by local government (if applicable)
                                                                                    (dd/mm/yy)




       15,. List balow all of th,e form’s and                   ,s.upporting’i(lfoi~aJi n that accompany this application (Inclu,de alllDAS
       forms, checklists, mandato.ry’supporting infbrmati r et9. thafWiJ.I.’ e-:’submitt.ed as’ part of this application. Note: this
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       question dO.es not apply for,’a,p,plic tibns m rd ,o.nJlO,e).l.~iOg,i$Jl1,al’t e.DA,)
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   Description of attachment or title of attachment                                                                                                                                Method of lodgement to
                                                                                                                                                                                   assessment manager




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116.Applicant’s declaration
       o By making this application, I declare that all information in this application is true and correct (Note:it is unlawful to
       provide false or misleading information.)




 6                                                                                                                                                                                                IDAS form 1-AppltciJuon d rai!s
                                                                                                                                                                                                    Version 2 0 17 December 20’/2