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DA Form 1 and Email with Photo and drawing - 9 Pines Ave, Lake Cooroibah

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       DA Form 1 - Development application details
       Approved form (version 1.3 effective 28 September 2020) made under section 282 of the Planning Act 2016.


       This form must be used to make a development application involving code assessment or impact assessment,
       except when applying for development involving only building work.
       For a development application involving building work only, use DA Form 2 - Building work details.
       For a development application involving building work associated with any other type of assessable development
       (i.e. material change of use, operational work or reconfiguring a lot), use this form (DA Form 1) and parts 4 to 6 of
       DA Form 2 - Building work details.
       Unless stated otherwise, all parts of this form must be completed in full and all required supporting information must
       accompany the development application.
       One or more additional pages may be attached as a schedule to this development application if there is insufficient
       space on the form to include all the necessary information.

        This form and any other form relevant to the development application must be used to make a development
        application relating to strategic port land and Brisbane core port land under the Transport Infrastructure Act 1994,
        and airport land under the Airport Assets (Restructuring and Disposal) Act 2008. For the purpose of assessing a
        development application relating to strategic port land and Brisbane core port land, any reference to a planning
        scheme is taken to mean a land use plan for the strategic port land, Brisbane port land use plan for Brisbane core
        port land, or a land use plan for airport land.
       Note: All terms used in this form have the meaning given under the Planning Act 2016, the Planning Regulation 2017, or the Development
             Assessment Rules (DA Rules).



       PART 1 - APPLICANT DETAILS
         1) Applicant details
         Applicant name(s) {individual or company full name)                                         -S /A          i -$    Ns/
         Contact name (only applicable for companies)

         Postal address (P.O. Box or street address)                               ? f /\/<= S
         Suburb                                                             AA(<E~ c oc?                        a H
         State
         Postcode
         Country
         Contact number                                                    c? 4 i
         Email address (non-mandatory)
         Mobile number (non-mandatory)
         Fax number (non-mandatory)
         Applicant’s reference number(s) (if applicable)

         2) Owner’s consent
         2.1) Is written consent of the owner required for this development application?
         □ Yes - the written consent of the owner(s) is attached to this development application
         L^No - proceed to 3)

                                            f^.L




Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023
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                                                                                                                             y Government
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     PART 2 - LOCATION DETAILS

        3) Location of the premises (complete 3.1) or 3.2), and 3.3) as applicable)
        Note: Provide details below and attach a site plan for any or all premises part of the development application. For further information, see DA
        Forms Guide: Relevant plans.
        3.1) Street address and lot on plan
        ® Street address AND lot on plan (all lots must be listed), or
        H Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in
          water but adjoining or adjacent to land e.g. jetty, pontoon. All lots must be listed).
                   Unit No.      Street No.       Street Name and Type                                        Suburb
                                                                                 Y' (         5                _____                         < *§■ A H
          a)
                   Postcode      Lot No.          Plan Type and Number (e.g. RP, SP)                          Local Government Area(s)


                   Unit No.      Street No.       Street Name and Type                                        Suburb

          b)
                   Postcode      Lot No.          Plan Type and Number (e.g. RP, SP)                          Local Government Area(s)


        3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or adjacent to land
             e.g. channel dredging in Moreton Bay)
        Note: Place each set of coordinates in a separate row.
            Coordinates of premises by longitude and latitude
        Longitude(s)                     Latitude(s)                         Datum                          Local Government Area(s) (if applicable)
                                                                         ]      WGS84
                                                                               GDA94
                                                                         |     Other:
            Coordinates of premises by easting and northing
        Easting(s)               Northing(s)              Zone Ref.          Datum                          Local Government Area(s) (if applicable)
                                                              54               WGS84
                                                              55               GDA94
                                                              56               Other: |

        3.3) Additional premises
          Additional premises are relevant to this development application and the details of these premises have been
          attached in a schedule to this development application
        O Not required


        4) Identify any of the following that apply to the premises and provide any relevant details
               In or adjacent to a water body or watercourse or in or above an aquifer
        Name of water body, watercourse or aquifer:
            On strategic port land under the Transport Infrastructure Act 1994
        Lot on plan description of strategic port land:
        Name of port authority for the lot:
               In a tidal area                                                    ____________________
        Name of local government for the tidal area (if applicable):
        Name of port authority for tidal area (if applicable):                    ____________________
            On airport land under the Airport Assets (Restructuring and Disposal) Act 2008
        Name of airport:



                                                                                                                                                   Page 2
                                                                                                                DA Form 1 - Development application details
                                                                                                                          Version 1.3-— 28 September 2020
Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

Page 3

             Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994

        EMR site identification:
             Listed on the Contaminated Land Register (CLR) under the Environmental Protection Act 1994

        CLR site identification:


        5) Are there any existing easements over the premises?
        Note: Easement uses vary throughout Queensland and are to be identified correctly and accurately. For further information on easements and
        how they may affect the proposed development, see DA Forms Guide,
             Yes - All easement locations, types and dimensions are included in plans submitted with this development
                  application
        13 No

     PART 3 - DEVELOPMENT DETAILS

     Section 1 - Aspects of development
        6.1) Provide details about the first development aspect
        a) What is the type of development? (tick only one box)
             Material change of use              Reconfiguring a lot              H Operational work                       Building work

        b) What is the approval type? (tick only one box)
        0 Development permit                     Preliminary approval             Q Preliminary approval that includes a variation approval

        c) What is the level of assessment?
        0 Code assessment                        Impact assessment (requirespublic notification)

        d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
             lots):                        Ay           0 Mscci AteO
                                                                                                      f 5T7
        e) Relevant plans
        Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms guide:
              Relevant plans.
             Relevant plans of the proposed development are attached to the development application
        6.2) Provide details about the second development aspect
        a) What is the type of development? (tick only one box)
              Material change of use             Reconfiguring a lot                  Operational work                     Building work

        b) What is the approval type? (tick only one box)
                                                                                                                                                             C\A
              Development permit                 Preliminary approval                 Preliminary approval that includes a variation approval

        c) What is the level of assessment?
             Code assessment                 O Impact assessment (requires public notification)

        d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
        lots)'.


       e) Relevant plans
       Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms Guide:
             Relevant plans.
              Relevant plans of the proposed development are attached to the development application

        6.3) Additional aspects of development
             Additional aspects of development are relevant to this development application and the details for these aspects
             that would be required under Part 3 Section 1 of this form have been attached to this development application
              Not required




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                                                                                                               DA Form 1 - Development application details
                                                                                                                         Version 1.3— 28 September 2020
Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

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     Section 2 - Further development details
        7) Does the proposed development application involve any of the following?
        Material change of use                  □ Yes - complete division 1 if assessable against a local planning instrument
        Reconfiguring a lot                     □ Yes - complete division 2
        Operational work                        □ Yes - complete division 3
        Building work                           □ Yes - complete DA Form 2 - Building work details

     Division 1 - Material change of use
      Note: This division is only required to be completed if any part of the development application involves a material change of use assessable against a
            local planning instrument.
        8.1) Describe the proposed material change of use
        Provide a general description of the                 Provide the planning scheme definition                 Number of dwelling         Gross floor
        proposed use                                         (include each definition in a new row)                 units (if applicable)      area (m2)
                                                                                                                                               (if applicable)




        8.2) Does the proposed use involve the use of existing buildings on the premises?
        □ Yes
        □ No

     Division 2 - Reconfiguring a lot
     Note: This division is only required to be completed if any part of the development application involves reconfiguring a lot.
        9.1) What is the total number of existing lots making up the premises?


        9.2) What is the nature of the lot reconfiguration? (tick all applicable boxes)
        □ Subdivision (complete 10))                                        □ Dividing land into parts by agreement (complete 11))
        □ Boundary realignment (complete 12))                               □ Creating or changing an easement giving access to a lot
                                                                              from a constructed road (complete 13))


        10) Subdivision
        10.1) For this development, how many lots are being created and what is the intended use of those lots:
        Intended use of lots created              Residential               Commercial                Industrial             Other, please specify:


        Number of lots created
        10.2) Will the subdivision be staged?
        □ Yes - provide additional details below
        □ No________________________
        How many stages will the works include?
        What stage(s) will this development application
        apply to?




                                                                                                                                                      Page 4
                                                                                                                   DA Form 1 - Development application details
                                                                                                                             Version 1.3— 28 September 2020
Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

Page 5

       11) Dividing land into parts by agreement - how many parts are being created and what is the intended use of the
           parts?
        Intended use of parts created             Residential              Commercial              Industrial               Other, please specify:


        Number of parts created


        12) Boundary realignment
        12.1) What are the current and proposed areas for each lot comprising the premises?
                                       Current lot                                                              Proposed lot
        Lot on plan description              Area (m2)                             Lot on plan description               Area (m2)




        12.2) What is the reason for the boundary realignment?



        13) What are the dimensions and nature of any existing easements being changed and/or any proposed easement?
        (attach schedule if there are more than two easements)
        Existing or              Width (m)           Length (m)     Purpose of the easement? (e.g.                      Identify the land/lot(s)
        proposed?                                                   pedestrian access)                                  benefitted by the easement




      Division 3 - Operational work
     Note: This division is only required to be completed if any part of the development application involves operational work.
        14.1) What is the nature of the operational work?
        □ Road work                                               □ Stormwater                         □ Water infrastructure
        □ Drainage work                                           □ Earthworks                         □ Sewage infrastructure
        □ Landscaping                                             □ Signage                            0 Clearing vegetation
        KI Other - please specify:
        14.2) Is the operational work necessary to facilitate the creation of new lots? (e.g. subdivision)
        □ Yes - specify number of new lots:
        0 No
        14.3) What is the monetary value of the proposed operational work? (include GST, materials and labour)
      5
      PART 4 - ASSESSMENT MANAGER DETAILS

        15) Identify the assessment manager(s) who will be assessing this development application
               Moo SA
        16) Has the local government agreed to apply a superseded planning scheme for this development application?
        □ Yes - a copy of the decision notice is attached to this development application
        □ The local government is taken to have agreed to the superseded planning scheme request - relevant documents
          attached
        0 No




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                                                                                                                DA Form 1 - Development application details
                                                                                                                          Version 1.3— 28 September 2020
Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

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        PART 5 - REFERRAL DETAILS
         17) Does this development application include any aspects that have any referral requirements?
         Note: A development application will require referral if prescribed by the Planning Regulation 2017.
         Ej No, there are no referral requirements relevant to any development aspects identified in this development
            application - proceed to Part 6
         Matters requiring referral to the Chief Executive of the Planning Act 2016:
   if   J^sClearing native vegetation
         □ Contaminated land (unexploded ordnance)
         | | Environmentally relevant activities (ERA) (only if the ERA has not been devolved to a local government)
         □ Fisheries - aquaculture
         □ Fisheries - declared fish habitat area
         □ Fisheries - marine plants
         □ Fisheries - waterway barrier works
         □ Hazardous chemical facilities
         □ Heritage places - Queensland heritage place (on or near a Queensland heritage place)
         □ Infrastructure-related referrals - designated premises
         □ Infrastructure-related referrals - state transport infrastructure
         □ Infrastructure-related referrals - State transport corridor and future State transport corridor
         □ Infrastructure-related referrals - State-controlled transport tunnels and future state-controlled transport tunnels
         □ Infrastructure-related referrals - near a state-controlled road intersection
         □ Koala habitat in SEQ region - interfering with koala habitat in koala habitat areas outside koala priority areas
         □ Koala habitat in SEQ region - key resource areas
         □ Ports - Brisbane core port land - near a State transport corridor or future State transport corridor
         EJ Ports - Brisbane core port land - environmentally relevant activity (ERA)
         □ Ports - Brisbane core port land - tidal works or work in a coastal management district
         □ Ports - Brisbane core port land - hazardous chemical facility
         □ Ports - Brisbane core port land - taking or interfering with water
         □ Ports - Brisbane core port land - referable dams
         □ Ports - Brisbane core port land - fisheries
         □ Ports - Land within Port of Brisbane’s port limits (below high-water mark)
         □ SEQ development area
         □ SEQ regional landscape and rural production area or SEQ rural living area - tourist activity or sport and
             recreation activity
         □ SEQ regional landscape and rural production area or SEQ rural living area - community activity
         □ SEQ regionallandscape and rural production area or SEQ rural living area - indoor recreation
         □ SEQ regional landscape and rural production area or SEQ rural living area - urban activity
         □ SEQ regional landscape and rural production area or SEQ rural living area - combined use
         □ Tidal works or works in a coastal management district
         □ Reconfiguring a lot in a coastal management district or for a canal
         □ Erosion prone area in a coastal management district
         □ Urban design
         □ Water-related development - taking or interfering with water
         □ Water-related development - removing quarry material (from a watercourse or lake)
         □ Water-related development - referable dams
         □ Water-related development -levees (category 3 levees only)
         □ Wetland protection area
         Matters requiring referral to the local government:
         □ Airport land
         | | Environmentally relevant activities (ERA) (only if the ERA has been devolved to local government)



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                                                                                                                DA Form 1 - Development application details
                                                                                                                          Version 1.3— 28 September 2020
Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

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        □ Heritage places - Local heritage places
        Matters requiring referral to the Chief Executive of the distribution entity or transmission entity:
        □ Infrastructure-related referrals - Electricity infrastructure
        Matters requiring referral to:
        • The Chief Executive of the holder of the licence, if not an individual
        • The holder of the licence, if the holder of the licence is an individual
        □ Infrastructure-related referrals - Oil and gas infrastructure
        Matters requiring referral to the Brisbane City Council:
        □ Ports - Brisbane core port land
        Matters requiring referral to the Minister responsible for administering the Transport Infrastructure Act 1994:
        | | Ports — Brisbane core port land (where inconsistent with the Brisbane port LUP for transport reasons)
        □ Ports - Strategic port land
        Matters requiring referral to the relevant port operator, if applicant is not port operator:
        □ Ports - Land within Port of Brisbane’s port limits (below high-water mark)

        Matters requiring referral to the Chief Executive of the relevant port authority:
        □ Ports - Land within limits of another port (below high-water mark)
        Matters requiring referral to the Gold Coast Waterways Authority:
        □ Tidal works or work in a coastal management district (in Gold Coast waters)
        Matters requiring referral to the Queensland Fire and Emergency Service:
        □ Tidal works or work in a coastal management district (involving a marina (more than six vessel berths))


        18) Has any referral agency provided a referral response for this development application?
        □ Yes - referral response(s) received and listed below are attached to this development application
        E No__________
        Referral requirement                                                   Referral agency                        Date of referral response




        Identify and describe any changes made to the proposed development application that was the subject of the
        referral response and this development application, or include details in a schedule to this development application
        (if applicable).




      PART 6 - INFORMATION REQUEST

        19) Information request under Part 3 of the DA Rules
        13 I agree to receive an information request if determined necessary for this development application
        □ I do not agree to accept an information request for this development application
        Note: By not agreeing to accept an information request I, the applicant, acknowledge:
         •   that this development application will be assessed and decided based on the information provided when making this development
             application and the assessment manager and any referral agencies relevant to the development application are not obligated under the DA
             Rules to accept any additional information provided by the applicant for the development application unless agreed to by the relevant
             parties
         •    Part 3 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules.
        Further advice about information requests is contained in the DA Forms Guide.




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                                                                                                           DA Form 1 - Development application details
                                                                                                                     Version 1.3— 28 September 2020
Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

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   V




       PART 7 - FURTHER DETAILS

        20) Are there any associated development applications or current approvals? (e.g. a preliminary approval)
        □ Yes - provide details below or include details in a schedule to this development application
        B No________________
        List of approval/development               Reference number                         Date                                 Assessment
        application references                                                                                                   manager
        □ Approval
        □ Development application
        □ Approval
        □ Development application


        21) Has the portable long service leave levy been paid? (only applicable to development applications involving building work or
            operational work)
        □ Yes - a copy of the receipted QLeave form is attached to this development application
        □ No - I, the applicant will provide evidence that the portable long service leave levy has been paid before the
           assessment manager decides the development application. I acknowledge that the assessment manager may
           give a development approval only if I provide evidence that the portable long service leave levy has been paid
        I3 Not applicable (e.g. building and construction work is less than $150,000 excluding GST)
        Amount paid                             Date paid (dd/mm/yy)                                QLeave levy number (A, B or E)
        $

        22) Is this development application in response to a show cause notice or required as a result of an enforcement
        notice?
       O Yes - show cause or enforcement notice is attached
       [S No

        23) Further legislative requirements___________________________________________________________
        Environmentally relevant activities
        23.1) Is this development application also taken to be an application for an environmental authority for an
        Environmentally Relevant Activity (ERA) under section 115 of the Environmental Protection Act 1994?
        □ Yes - the required attachment (form ESR/2015/1791) for an application for an environmental authority
          accompanies this development application, and details are provided in the table below
        □ No
        Note: Application for an environmental authority can be found by searching “ESR/2015/1791" as a search term at www.qld.qov.au. An ERA
        requires an environmental authority to operate. See www.business.qld.qov.au for further information.
        Proposed ERA number:                                                        Proposed ERA threshold:
        Proposed ERA name:
        □ Multiple ERAs are applicable to this development application and the details have been attached in a schedule to
          this development application.
        Hazardous chemical facilities
        23.2) Is this development application for a hazardous chemical facility?
        O Yes - Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this development
          application
        □ No
        Note: See www. business, qld. ciov.au for further information about hazardous chemical notifications.




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                                                                                                                DA Form 1 - Development application details
                                                                                                                          Version 1.3— 28 September 2020
Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

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        4




        Clearing native vegetation
        23.3) Does this development application involve clearing native vegetation that requires written confirmation that
        the chief executive of the Vegetation Management Act 1999 is satisfied the clearing is for a relevant purpose under
        section 22A of the Vegetation Management Act 1999?
        □ Yes - this development application includes written confirmation from the chief executive of the Vegetation
          Management Act 1999 (s22A determination)
          No
        Note: 1. Where a development application for operational work or material change of use requires a s22A determination and this is not included,
                 the development application is prohibited development.
              2. See https://www.qld.qov.au/environment/land/veqetation/applYinq for further information on how to obtain a s22A determination.

        Environmental offsets
        23.4) Is this development application taken to be a prescribed activity that may have a significant residual impact on
        a prescribed environmental matter under the Environmental Offsets Act 2014?
        □ Yes - I acknowledge that an environmental offset must be provided for any prescribed activity assessed as
          having a significant residual impact on a prescribed environmental matter
        □ No
        Note: The environmental offset section of the Queensland Government’s website can be accessed at www.qld.qov.au for further information on
        environmental offsets.

        Koala habitat in SEQ Region
        23.5) Does this development application involve a material change of use, reconfiguring a lot or operational work
        which is assessable development under Schedule 10, Part 10 of the Planning Regulation 2017?
        □ Yes - the development application involves premises in the koala habitat area in the koala priority area
        □ Yes - the development application involves premises in the koala habitat area outside the koala priority area
        □ No
        Note: If a koala habitat area determination has been obtained for this premises and is current over the land, it should be provided as part of this
        development application. See koala habitat area guidance materials at www.des.qld.qov.au for further information.


        Water resources
        23.6) Does this development application involve taking or interfering with underground water through an
        artesian or subartesian bore, taking or interfering with water in a watercourse, lake or spring, or taking
        overland flow water under the Water Act 2000?
        □ Yes - the relevant template is completed and attached to this development application and I acknowledge that a
          relevant authorisation or licence under the Water Act 2000 may be required prior to commencing development
        □ No
        Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.qld.qov.au for further information.
        DA templates are available from https://planninq. dsdmip. qld. gov.au/. If the development application involves:
        • Taking or interfering with underground water through an artesian or subartesian bore: complete DA Form 1 Template 1
        • Taking or interfering with water in a watercourse, lake or spring: complete DA Forml Template 2
        • Taking overland flow water: complete DA Form 1 Template 3.
        Waterway barrier works
        23.7) Does this application involve waterway barrier works?
        □ Yes - the relevant template is completed and attached to this development application
        □ No
        DA templates are available from https://planninq. dsdmip. qld.qov. au/. For a development application involving waterway barrier works, complete
        DA Form 1 Template 4.

        Marine activities
        23.8) Does this development application involve aquaculture, works within a declared fish habitat area or
        removal, disturbance or destruction of marine plants?
        □ Yes - an associated resource allocation authority is attached to this development application, if required under
          the Fisheries Act 1994
        □ No
        Note: See guidance materials at www.daf.qld.qov.au for further information.



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        Quarry materials from a watercourse or lake
        23.9) Does this development application involve the removal of quarry materials from a watercourse or lake
        under the Water Act 2000?
        □ Yes - I acknowledge that a quarry material allocation notice must be obtained prior to commencing development
        □ No
        Note: Contact the Department of Natural Resources, Mines and Energy at www. dnrme. qld. qov.au and www. business, qld. qov.au for further
        information.
        Quarry materials from land under tidal waters
        23.10) Does this development application involve the removal of quarry materials from land under tidal water
        under the Coastal Protection and Management Act 1995?
        □ Yes - I acknowledge that a quarry material allocation notice must be obtained prior to commencing development
        □ No
        Note: Contact the Department of Environment and Science at www.des.qld.qov.au for further information.

        Referable dams
        23.11) Does this development application involve a referable dam required to be failure impact assessed under
        section 343 of the Water Supply (Safety and Reliability) Act 2008 (the Water Supply Act)?
        □ Yes - the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the Water
          Supply Act is attached to this development application
        □ No
        Note: See guidance materials at www.dnrme.qld.qov.au for further information.

        Tidal work or development within a coastal management district
        23.12) Does this development application involve tidal work or development in a coastal management district?
        □ Yes - the following is included with this development application:
           □    Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required
                    if application involves prescribed tidal work)
           □ A certificate of title
        □ No
        Note: See guidance materials at www.des.qld.qov.au for further information.
        Queensland and local heritage places
        23.13) Does this development application propose development on or adjoining a place entered in the Queensland
        heritage register or on a place entered in a local government’s Local Heritage Register?
        □ Yes - details of the heritage place are provided in the table below
        □ No
        Note: See guidance materials at www.des.qld.qov.au for information requirements regarding development of Queensland heritage places.
        Name of the heritage place: I                                            Place ID:

        Brothels
        23.14) Does this development application involve a material change of use for a brothel?
        □ Yes - this development application demonstrates how the proposal meets the code for a development
          application for a brothel under Schedule 3 of the Prostitution Regulation 2014
        □ No
        Decision under section 62 of the Transport Infrastructure Act 1994
        23.15) 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




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                                                                                                             DA Form 1 - Development application details
                                                                                                                       Version 1.3— 28 September 2020
Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

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        4




        Walkable neighbourhoods assessment benchmarks under Schedule 12A of the Planning Regulation
        23.16) 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.planninq.dsdmip.qld.qov.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                                                                                        S 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                               [3 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       0 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       [3 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)                                                                                0 Not applicable


        25) Applicant declaration
        0 By making this development application, I declare that all information in this development application is true and
          correct
        0 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.
        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.




                                                                                                                                                  Page 11
                                                                                                                DA Form 1 - Development application details
                                                                                                                          Version 1.3— 28 September 2020
Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

Page 12

     PART 9 - FOR COMPLETION OF THE ASSESSMENT MANAGER - FOR OFFICE
     USE ONLY

        Date received:                                   Reference number(s):


        Notification of engagement of alternative assessment 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
        Note: For completion by assessment manager if applicable
        Description of the work
        QLeave project number
        Amount paid ($)                                                  Date paid (dd/mm/yy)
        Date receipted form sighted by assessment manager
        Name of officer who sighted the form




                                                                                                                                  Page 12
                                                                                                DA Form 1 - Development application details
                                                                                                          Version 1.3— 28 September 2020
Document Set ID: 22589826
Version: 1. Version Date: 20/09/2023

Page 13

 4




                From:                   "Morgan Gaffney"
                Sent:                   Wed, 20 Sep 2023 12:35:26 +1000
                To:                     "[email protected]" <[email protected]>
                Bcc:                    "Daniel Epps" <[email protected]>
                Subject:                Driveway Replacement - 9 Pines Avenue, Cooroibah
                Attachments:            DAForml-Developmentapplicationdetails.docx



                 Hi Howard,

                We spoke on the phone last week regarding your options on replacing the driveway at your
                property at 9 Pines Avenue, Cooroibah. I appreciate your patience as I wanted to raise the
                issues you mentioned with some of the management staff to get the best outcome for yourself
                moving forward. After some discussion, I have two potential options for you:

                 Option 1 - Council would be willing to support the removal of the tree in conjunction with the
                 new driveway construction works. As part of the works, we would also condition a replacement
                 street tree of a more suitable species and location. The cost of the works (including the tree
                 removal and replacement) would need to be covered by yourself as it is related to your property
                 access. Under our current fees, the cost for the application would be $593 + $56 as listed
                 below.


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Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

Page 14

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Page 15

                                                                                                 Local Government Act
                 Base Fee - Vehicle Crossover                                     $593.00                                      N     Application Fee
                                                                                                    2009 | 97 (2)(a)
                 Operational Works - Tree Removal fee per tree 1 to 8                            Local Government Act
                                                                                   $56.00                                      N     Application Fee
                 trees                                                                              2009 | 97 (2)(a)

                Option 2 - You could also pursuit just the driveway replacement. Council would however require an arborist report to determine the
                impacts to the existing tree from the driveway construction if it is to be retained. The application fee from Council would be the $593
                for the vehicle crossover.


                With any development application to Council we will also need to see some formal plans certified by an engineer to demonstrate the
                driveway has been designed in accordance with standard drawings and guidelines. You may also need to update the development
                application form which I have attached to this email depending on which option you choose. Please email any application lodgement
                to [email protected] you have any further questions please don’t hesitate to contact me.

                 Kind regards,

                 Morgan Gaffney
                 Senior Engineer - Development and Regulation
                 Phone: 07 5329 6370

                 [email protected] | noosa.qld.qov.au


                     Kf NOOSA
                                 Council
                \NoosaCouncilrespectfully acknowledges the Traditional Custodians of the lands and waters of the Noosa area, the Kabi Kabi
                2teople. and pays respect to their Elders, past, present and emerging. |                    .        s    B

                 Please consider the environment before printing this email




Document Set ID: 22589826
Version: 1, Version Date: 20/09/2023

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