Operational Works Application OPW21/0044 - DA Form 1 - Cover Letter - Plans - copy 15203 DA - 77 Shorehaven Dr Noosa Waters

PART 9 - FOR COMPLETION OF THE ASSESSMENT MANAGER - 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 (dd/mm/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 1.2— 7 February 2020