DA Form 1

 ☐ Yes – details of the heritage place are provided in the table below
 ☒ No
 Note: See guidance materials at www.desi.qld.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.qldgov.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?
 ☐ 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)
 ☒ 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?
 ☐ Yes – Schedule 12A is applicable to the development application and the assessment benchmarks contained in
 schedule 12A have been considered
 ☒ No
 Note: See guidance materials at www.planning.statedevelopment.qld.gov.au for further information.



PART 8 – CHECKLIST AND APPLICANT DECLARATION
 24) Development application checklist
 I 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 to 6 of DA Form 2 –                            ☐ Yes
 Building work details have been completed and attached to this development application                               ☒ 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       ☒ 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       ☒ 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                              ☐ Yes
 development permit is issued (see 21)                                                                                ☒ Not applicable



 25) Applicant declaration
 ☒ By making this development application, I declare that all information in this development application is true and
   correct
 ☒ Where an email address is provided in Part 1 of this form, I 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.




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