DA Form 1

List of approval/development                 Reference number                          Date                                      Assessment
application references                                                                                                           manager
☐ 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 (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?
☐ Yes – show cause or enforcement notice is attached
☒ No


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:                                                           Proposed ERA threshold:
Proposed ERA name:
☐ 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?
☐ Yes – Form 536: 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.



                                                                                                                                                Page 9
                                                                                                             DA Form 1 – Development application details
                                                                                                                           Version 1.6— 2 August 2024