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

        □ 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