Updated DA Form 1 - 35 Mary River Road, Cooroy

 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                   ☐ 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):
 Development Permit for Material Change of Use for an Extension to an Existing Club, Indoor Sport and Recreation
 and Oval Lighting.
 e) Relevant plans
 Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms guide:
       Relevant plans.
 ☒ Relevant plans of the proposed development are attached to the development application
 6.2) Provide details about the second development aspect
 a) What is the type of development? (tick only one box)
 ☐ Material change of use             ☐ Reconfiguring a lot                ☐ Operational work                   ☐ Building work
 b) What is the approval type? (tick only one box)
 ☐ Development permit                 ☐ Preliminary approval                ☐ Preliminary approval that includes a variation approval
 c) What is the level of assessment?
 ☐ Code assessment                    ☐ Impact assessment (requires public notification)
 d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
 lots):


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



                                                                                                                                           Page 3
                                                                                                        DA Form 1 – Development application details
                                                                                                                  Version 1.3— 28 September 2020