Operational Works Application OPW18/0124 - 185 Dr Pages Rd Cootharaba

 

 

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

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:

* 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

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

* 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 OFFICE USE ONLY

 

Date receivedReference number(s):

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 project number

Amount paid ($)

Date paid

Date receipted form sighted by assessment manager

Name of officer who sighted the form