DA Form 1

Identify and describe any changes made to the proposed development application that was the subject of the
referral response and the development application the subject of this form, 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
    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.

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
    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
   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
$

22) Is this development application in response to a show cause notice or required as a result of an enforcement
notice?
    Yes – show cause or enforcement notice is attached
    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


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