DA Form 1 - 16 Rene Street Noosaville - OPW24-0138 & MCU210104.01

Page 2

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[X] Street address AND lot on plan (all lots must be listed), Or
CO 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
16 Rene Street Noosaville
#1 Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
4566 13 RP 150347 Noosa Council
Unit No. Street No. | Street Name and Type Suburb
b)
Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
oord ates OT pre €S (appro e for aeveiopme emole are. over part OF 2 /0l O, er not aajo. or aqjacent to
i) (a 9 oreton B
O Place ea eto. ‘ele) eparate ro
C1 Coordinates of premises by longitude and latitude
Longitude(s) Latitude(s) Datum Local Government Area(s) (if applicable)
LJ wese4
LJ GDA94
UC Other:
LJ Coordinates of premises by easting and northing
Easting(s) Northing(s) Zone Ref. | Datum Local Government Area(s) (if applicable)
0154 CO wess4
1155 CL] GDA94
C156 CJ Other:

 

 

 

 

 

3.3) Additional premises

LC Additional premises are relevant to this development application and the details of these premises have been
attached in a schedule to this development application

I Not required

 

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

 

CJ In or adjacent to a water body or watercourse or in or above an aquifer
Name of water body, watercourse or aquifer: |

LJ On strategic port land under the Transport Infrastructure Act 1994

Lot on plan description of strategic port land:

Name of port authority for the lot:

UJ Ina tidal area

Name of local government for the tidal area (if applicable):
Name of port authority for tidal area (if applicable)

 

 

 

 

 

 

 

 

 

 

 

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DA Form 1 — Development application details
Version 1.6— 2 August 2024

Page 3

 

CJ On airport land under the Airport Assets (Restructuring and Disposal) Act 2008

Name of airport: |

CD Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994
EMR site identification: |

LJ 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.

KX] Yes — All easement locations, types and dimensions are included in plans submitted with this development
application
LINo

 

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)

 

 

 

 

 

 

LO Material change of use [LJ Reconfiguring a lot KX] Operational work D1 Building work

b) What is the approval type? (tick only one box)

KX] Development permit UJ Preliminary approval C Preliminary approval that includes a variation approval

c) What is the level of assessment?

KK] Code assessment CJ 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):

 

Concrete carpark & stormwater to rear of premises

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

KX] 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)

 

 

 

 

 

L] Material change of use _[_] Reconfiguring a lot LO Operational work DD Building work

b) What is the approval type? (tick only one box)

CJ Development permit O Preliminary approval UJ Preliminary approval that includes a variation approval
c) What is the level of assessment?

LJ Code assessment CJ 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.

CJ Relevant plans of the proposed development are attached to the development application

 

 

 

 

Queensland
Government

 

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6.3) Additional aspects of development

C1 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

&X] Not required

6.4) Is the application for State facilitated development?

LC Yes - Has a notice of declaration been given by the Minister?

KX] No

    
     

  

 

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

 

 

 

 

Material change of use LD Yes - complete division 1 if assessable against a local planning instrument
Reconfiguring a lot LJ Yes — complete division 2

Operational work KI Yes — complete division 3

Building work C1 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
Jocal planning instrument.

8.1) Describe the proposed material change of use

 

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

 

 

 

 

 

 

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

0 Yes
LNo

8.3) Does the proposed development relate to temporary accepted development under the Planning Regulation?

C1 Yes — provide details below or include details in a schedule to this development application
[No

Provide a general description of the temporary accepted development Specify the stated period dates
under the Planning Regulation

 

 

 

 

 

 

 

 

 

 

 

 

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)

 

 

 

 

 

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

 

Queensland
Government

 

Page 5

10) Subdivision

 

10.1) For this development, how many lots are Pent ence and what is the intended use of meee ee
Intended use of lots created Residential Commercial Industrial Other, please specify:

 

 

 

 

 

 

Number of lots created

 

10.2) Will the subdivision be staged?

C1 Yes — provide additional details below
[LI 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
fey laoe

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

 

 

 

 

 

 

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 (m?) Lot on plan description Area (m?)

 

 

 

 

 

 

 

 

 

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)

 

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

CZ Road work KX] Stormwater CD Water infrastructure

        
    
    
 
 

 
   
  

  

 

CJ Drainage work LC Earthworks LC Sewage infrastructure
XX] Landscaping LD Signage C Clearing vegetation
&X] Other — please specify: Carparking

14.2) Is the operational work necessary to facilitate the creation of new lots? (e.g. subdivision)
CJ Yes — specify number of new lots:

| BX No

 

 

 

       

 

B

  

‘fo Queensland
mae Government

  

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14.3) What is the monetary value of the proposed operational work? (include GST, materials and labour)
$38,500.00

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?

 

 

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

LD The local government is taken to have agreed to the superseded planning scheme request — relevant documents
attached

No

 

PART 5 — REFERRAL DETAILS

17) Does this development application include any aspects that have any referral requirements?

 

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

EX] 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 Act 2016:

CO Clearing native vegetation

C1 Contaminated land (unexploded ordnance)

CH Environmentally relevant activities (ERA) (only if the ERA has not been devolved to a local government)

C Fisheries — aquaculture

CH Fisheries — declared fish habitat area

CU Fisheries — marine plants

LJ Fisheries — waterway barrier works

CJ Hazardous chemical facilities

CL Heritage places — Queensland heritage place (on or near a Queensland heritage place)

(C1 Infrastructure-related referrals — designated premises

CJ Infrastructure-related referrals — state transport infrastructure

C Infrastructure-related referrals — State transport corridor and future State transport corridor

C1 Infrastructure-related referrals — State-controlled transport tunnels and future state-controlled transport tunnels

(J Infrastructure-related referrals — near a state-controlled road intersection

CL Koala habitat in SEQ region — interfering with koala habitat in koala habitat areas outside koala priority areas

LO Koala habitat in SEQ region — key resource areas

CJ Ports — Brisbane core port land — near a State transport corridor or future State transport corridor

C1 Ports — Brisbane core port land — environmentally relevant activity (ERA)

C1 Ports — Brisbane core port land — tidal works or work in a coastal management district

C Ports — Brisbane core port land — hazardous chemical facility

LC Ports — Brisbane core port land — taking or interfering with water

C1 Ports — Brisbane core port land — referable dams

CJ Ports — Brisbane core port land — fisheries

C Ports — Land within Port of Brisbane’s port limits (below high-water mark)

(J SEQ development area

C1 SEQ regional landscape and rural production area or SEQ rural living area — tourist activity or sport and
recreation activity

CJ SEQ regional landscape and rural production area or SEQ rural living area — community activity

C1 SEQ regional landscape and rural production area or SEQ rural living area — indoor recreation

C SEQ regional landscape and rural production area or SEQ rural living area — urban activity

(J SEQ regional landscape and rural production area or SEQ rural living area — combined use

CJ SEQ northern inter-urban break — tourist activity or sport and recreation activity

 

 

 

 

    

Queensland
Government

es

 

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CJ SEQ northern inter-urban break — community activity

CJ SEQ northern inter-urban break — indoor recreation

CJ SEQ northern inter-urban break — urban activity

(J SEQ northern inter-urban break — combined use

C Tidal works or works in a coastal management district

LJ Reconfiguring a lot in a coastal management district or for a canal
CJ Erosion prone area in a coastal management district

C1 Urban design

C1 Water-related development — taking or interfering with water

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

C1 Water-related development —levees (category 3 levees only)

CJ] Wetland protection area

 

Matters requiring referral to the local government:

C Airport land

CJ Environmentally relevant activities (ERA) (only if the ERA has been devolved to local government)
CJ Heritage places — Local heritage places

 

Matters requiring referral to the Chief Executive of the distribution entity or transmission entity:
C1 Infrastructure-related referrals — Electricity infrastructure

 

Matters requiring referral to:

e The Chief Executive of the holder of the licence, if not an individual
e The holder of the licence, if the holder of the licence is an individual
CJ Infrastructure-related referrals — Oil and gas infrastructure

 

Matters requiring referral to the Brisbane City Council:
C1 Ports — Brisbane core port land

 

Matters requiring referral to the Minister responsible for administering the Transport Infrastructure Act 1994:
LJ Ports — Brisbane core port land (where inconsistent with the Brisbane port LUP for transport reasons)
CJ Ports — Strategic port land

 

Matters requiring referral to the relevant port operator, if applicant is not port operator:
CJ Ports — Land within Port of Brisbane’s port limits (below high-water mark)

 

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

 

Matters requiring referral to the Gold Coast Waterways Authority:
C1 Tidal works or work in a coastal management district (in Gold Coast waters)

 

Matters requiring referral to the Queensland Fire and Emergency Service:
LJ Tidal works or work in a coastal management district (involving a marina (more than six vessel berths))

 

18) Has any referral agency provided a referral response for this development application?
LJ Yes — referral response(s) received and listed below are attached to this development application

KX] No

 

 

Referral requirement Referral agency Date of referral response

 

 

 

 

 

Identify and describe any changes made to the proposed development application that was the subject of the
referral response and this development application, or include details in a schedule to this development application
(if applicable).

 

 

 

 

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DA Form 1 — Development application details
Version 1.6— 2 August 2024

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PART 6 — INFORMATION REQUEST

19) Information request under the DA Rules

 

KX] | agree to receive an information request if determined necessary for this development application
[1 | do not agree to accept an information request for this development application

Note: By not agreeing to accept an information request |, the applicant, acknowledge:

e _ 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
Raies to accept any additional information provided by the applicant for the development application unless agreed to by the relevant
parties

e Part 3 under Chapter 1 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules or

e Part 2under Chapter 2 of the DA Rules will still apply if the application is for state facilitated development

Further advice about information requests is contained in the DA Forms Guide.

PART 7 — FURTHER DETAILS

20) Are there any associated development applications or current approvals? (e.g. a preliminary approval)
XX] Yes — provide details below or include details in a schedule to this development application

CI No

 

 

 

 

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

Bd Approval —_ MCU21/0104.01 16 June 2022 Rogae Sewn
C1 Development application

Bal Approat MCU21/0104.01 16 May 2024 Nooaa Counell

 

 

 

LJ Development application

 

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

 

operational work)

C1 Yes — a copy of the receipted QLeave form is attached to this development application

LJ 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. | acknowledge that the assessment manager may
give a development approval only if | provide evidence that the portable long service leave levy has been paid

XJ 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 (A, B or E)
$

 

 

 

 

 

22) Is this development application in response to a show cause notice or required as a result of an enforcement
notice?

CJ Yes - show cause or enforcement notice is attached

KI No

 

 

 

 

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DA Form 1 — Development application details
Version 1.6— 2 August 2024

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23) Further legislative requirements
En mentally relevant ac’ 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?

C1 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

KX] 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.gid.gov.au for further information.

 

 

Proposed ERA number: Proposed ERA threshold:

 

 

Proposed ERA name:

 

 

 

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

 

LD Yes — Form 536: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this development
application

KX] No

Note: See www.business.aid.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?

C Yes — this development application includes written confirmation from the chief executive of the Vegetation
Management Act 1999 (s22A determination)

KX] 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.ald.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?

C1 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

XI 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 habitat in SEQ Region

 

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

 

CJ Yes — the development application involves premises in the koala habitat area in the koala priority area
CJ Yes — the development application involves premises in the koala habitat area outside the koala priority area
KI No

Note: /f a koala habitat area determination has been obtained for this premises and is current over the land, it should be provided as part of this
development application. See koala habitat area guidance materials at www.desi.gid.gov.au for further information.

 

 

   
  

a D Queensland

ay Government

 
  

 

Page 10

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?

LO 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

KI No

Note: Contact the Department of Resources at www.resources.qid.gov.au for further information.

 

DA templates are available from planning. statedevelopment.qid.gov.au. If the development application involves:

e Taking or interfering with underground water through an artesian or subartesian bore: complete DA Form 1 Template 1
e Taking or interfering with water in a watercourse, lake or spring: complete DA Form1 Template 2

e Taking overland flow water: complete DA Form 1 Template 3.

 

 

 

 

23.7) Does

C1 Yes - the relevant template is completed and attached to this development application

KX] No

DA templates are available from planning. statedevelopment.gid.gov.au. For a development application involving waterway barrier works,
complete DA Form 1 Template 4.

 

  

 

Marine act 3

23.8) Does this development application involve aquaculture, works within a declared fish habitat area or
removal, disturbance or destruction of marine plants?

LJ 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.gid.gov.au for further information.
COTE Tia ME dE Mice) ie MVE Ll Reel etme) mL)

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

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

KI No
Note: Contact the Department of Resources at www.resources.gid.gov.au_and www.business.qid.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?

C1 Yes — | acknowledge that a quarry material allocation notice must be obtained prior to commencing development

EX] No

Note: Contact the Department of Environment, Science and Innovation at www.desi.gid.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)?

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

KX] No

Note: See guidance materials at www.resources.gid.gov.au for further information.

 

  

=) Queensland
ee Government

Page 11

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?

 

C1 Yes — the following is included with this development application:
L Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required
if application involves prescribed tidal work)
OC Acertificate of title
I No

Note: See guidance materials at www.desi.gid.gov.au for further information.

Queensland and local ge 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?

LJ Yes - details of the heritage place are provided in the table below

KI No

Note: See guidance materials at www.desi.gid.gov.au for information requirements regarding development of Queensland heritage places.

For a heritage place that has cultural heritage significance as a local heritage place and a Queensland heritage place, provisions are in place
under the Planning Act 2016 that limit a local categorising instrument from including an assessment benchmark about the effect or impact of,
development on the stated cultural heritage significance of that place. See guidance materials at www.planning.statedevelopment.qidgov.au for
information regarding assessment of Queensland heritage places.

   

 

Name of the heritage place: Place ID:

Decision under section 62 of the Transport Infrastructure Act 1994
23.14) Does this development application involve new or changed access to a state-controlled road?

0 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)

KI No
Walkable neighbourhoods assessment benchmarks under Schedule 12A of the Planning Regulation

 

 

23.15) Does this development application involve reconfiguring a lot into 2 or more lots in certain residential zones
(except rural residential zones), where at least one road is created or extended?

CJ Yes — Schedule 12A is applicable to the development application and the assessment benchmarks contained in
schedule 12A have been considered

KI No

Note: See guidance materials at www.planning.statedevelopment.gid.gov.au for further information.

 

 

 

PART 8 — CHECKLIST AND APPLICANT DECLARATION

 

24) Development applicati ecklist
| 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 to6 of DAForm 2- [] Yes
Building work details have been completed and attached to this development application XX] Not applicable

 

Supporting information addressing any applicable assessment benchmarks is with the
development application

Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report Oo Yes
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. For further X Yes
information, see DA Forms Guide: Relevant plans.
The portable long service leave levy for QLeave has been paid, or will be paid before a OO Yes

development permit is issued (see 27) XJ Not applicable

 

 

 

 

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25) Applicant declaration

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

KX] 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.

 

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:

e 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

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

e 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 COMPLETION OF THE ASSESSMENT MANAGER - FOR OFFICE
USE ONLY

 

Date received: [sd 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

 

 

 

 

Description of the work

QLeave notification and payment
Note: For completion by assessment manager if applicable

 

QLeave project number

 

Amount paid ($) | Date paid (dd/mmi/yy)

 

Date receipted form sighted by assessment manager

 

Name of officer who sighted the form

 

 

 

 

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DA Form 1 — Development application details
Version 1.6— 2 August 2024