Operational Works Application OPW17-0552 · OPW17/0552

Department of Infrastructure, Local Government and Plannin

PART 9 — FOR OFFICE USE ONLY

Date received: [ Reference number(s): |

Nettie Ue (6) cine Welstintrl oli clita is eect 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

 

Z Note: FOr completion by assessment EME ea joule:
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

 

 

 

 

 

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
infrastructure, Local Government and Planning. This form and all other required development application materials should
be sent to the assessment manager.

Page 11
DA Form 1 ~ Development Application details
Version 1.0—3 July 2017