Development Application Vegetation Removal Idas Forms 1 & 6 - OPW120597 · OPW12/0597

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Privacy-the information collected in this form will be used by the Department of Infrastructure and Planning (DIP)in
accordance with the processing and assessment of your application. Your personal details will not be disclosed for a purpose
outside of the IDAS process, except where required by legislation (including the Right to Information Act 2009)or as required

by Parliament. This information may be stored in a departmental database. The information collected will be retained as
required by the Public Records Act 2002.



OFFICE USE ONLY

 Date received
                     I                                     .eference numbers         I
NOTIFICATION OF ENGAGEMENT OF A  PR~IFIER
 To                                        Council. I have been engaged as the private certifier for the building work referred


                            /
                                 /         to in this application



                          /                                                                                  Building
Date of                   Name                                            BSA Certification license number
          engageme’y                                                                                         classification/s
                 ,




                                           /1’
QlEAVE N OTI FICATION AN 0 PAYMENT (for _ mp etlOn b y assessment manager or private certifier if applicable
                                                                                                           )
                                                                                           Date receipted


Description of the work
                                 ~roject
                                  Number
                                                         Amount paid

                                                         ($)
                                                                              Date paid
                                                                                          form sighted by

                                                                                           assessment
                                                                                                              Name of officer who

                                                                                                              sighted the form
                          /                                                                manager


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  The Sustainable PlanningAct 20      (SPA)is administered by the Department of Infrast       cture and Planning. This form and

  all other required application ma   rials should be sent to your assessment manager        d any referral agencies.




                 7                                                                          Application details-/DAS form 1
                                                                                              Version 1.0 18 December 2009