207-06-DAForm1 · OPW19/0068

QLeave notification and payment
Note: For completion by assessment manager if applicable
Description of the work                                    Proposed Driveway
QLeave project number                                      N/A
Amount paid ($)                                            N/A
Date paid                                                  N/A
Date receipted form sighted by assessment manager          N/A
Name of officer who sighted the form                       N/A




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                                                                               DA Form 1 – Development Application details
                                                                                             Version 1.1— 22 JUNE 2018