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Department of Infrastructure, Local Government and P

 

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

(J Street address AND lot on plan (ail lots must be listed), Or

(C1 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
ALY ns: :
a) =o iT LOAN ot hia ae
Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
t +} DD
as Til s RY &qOGaq F
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. Only one set of coordinates is required for this part.

 

L\Coordinates of premises by longitude and latitude i
Longitude(s) a Latitude(s) Datum > Local Government Area(s) (if applicable)
LJ wess4 *
| LJ GDA94
(J Other:

 

 

 

 

 

L\Coordinates of premises by easting and northing

 

 

 

Easting(s) aa Northing(s) | Zone Ref. | Datum ig __| Local Government Area(s) (if applicable)
| | (O54 — Cwese4
| 'C155 | Clepaga

 

| L156 _ LJ Other:
3.3) Additional premises

(lAdditional premises are relevant to this development application and their details have been attached in a schedule
to this application
BxINot required

 

 

 

4) Identify any of the following that apply to the premises and provide any relevant details
Lin or adjacent to a water body or watercourse or in or above an aquifer

 

Name of water body, watercourse or aquifer:
(JOn strategic port land under the Transport Infrastructure Act 1994
Lot on plan description of strategic port land: ‘
Name of port authority for the lot:

Clin a tidal area

Name of local government for the tidal area (if applicable):

Name of port authority for tidal area (if applicable):

CJ On airport land under the Airport Assets (Restructuring and Disposal) Act 2008
Name of airport: |
Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994
EMR site identification: |

 

 

 

 

 

 

 

 

 

 

 

 

 

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Department of Infrastructure, Local Government and P

 

 

J 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.

LJ Yes — All easement locations, types and dimensions are included in plans submitted with this development
y application 4
ANo

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) yr
ae change of use LJ Reconfiguring a lot see atone work uilding work
b) What is the approval type? (tick only one box)
i permit C] Preliminary approval ]Preliminary approval that includes
a variationapproval
c) Wat is the level of assessment?
es assessment (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): hee ‘ '
extva ANY SPL Wir VA Seat “4 ;
(

 

e) Relevant plans :

Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Formsquide:

   

 

Relevant plans.

od 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)

 

 

L] Material change of use L] Reconfiguring a lot {] Operational work ] Building work

b) What is the approval type? (tick only one box)

(J Development permit (Preliminary approval LJPreliminary approval that includes a variation
approval

 

c) What is the level of assessment?
(]Code assessment (impact assessment(requires public notification)
d) Provide a brief description of the proposal (e.g. 6unit 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.

LJ Relevant plans of the proposed development are attached to the development application

  

6.3) Additional aspectsof development

] Additional aspects of development are relevant to this development application and the details for these aspectsthat
would be required under Part 3 Section ‘of this form have been atiached to this development application

(INot required

 

 

 

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Department of Infrastructure, Local Government and PI

Section 2 — Further development details
7) Does the proposed development application involve any of the following?

Material change of use [W]lYes — complete division 1 if assessable against a local planning instrument
Reconfiguring a lot C] Yes — complete division 2

Operational work L] Yes — complete division 3

Building work bd Yes — completeDAForm 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 lot
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 (m?)
(if applicable)
Undaveove, V) aw Vv Ma var \_ pawn LAB aa
x* ff) ..aA acl “ oe
= Bes zuelek OW.

 

 

8.2) Does the proposed use involve the use of existing buildings os the premises?

 

 

LINo

 

2

 

 

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
(Subdivision (complete 10))

all applicable boxes)

 

(] Dividing land into parts by agreement (complete 11)

 

L]Boundary realignment (complete 12))

[Creating or changing an easement giving access to a lot from a
construction road(complete 13))

 

   
  
 

10) Subdivision

Intended use of lots created Residential

  

10.1) For this development, how many lots are being created and what is the intended use of those lots
Commercial

  
  
  

Industrial

     

    
 

Other, please specify:

 

 

   

Number of lots created
10.2) Will the subdivision be staged?
LJ Yes — provide additional details below

[] No

 

  
  

 

How many stages will the works include?

 

What stage(s) will this development application
apply to?

 

 

  

parts?
Intended use of parts created

      

Residential

Number of parts created

 

 

11) Dividing land into parts by agreement — how many parts are being created and what is the intended use of the

Commercial

  
      
 

   

  

Industrial

  

Other, please specify:

 

 

 

 

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Department of Infrastructure, Local Government and

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 (m’) Lot on plan description Area (m?)

 

 

 

 

 

 

 

 

12.2) What is the reason for the boundary realignment?

 

 

13) What are the dimen: and nature of any existing easements being changed and/or any proposed easeme’
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 becompleted if any part of the development application involves operational work.

14.1) What is the nature of the operational work?

L] Road work (_|Stormwater (Water infrastructure
(Drainage work (Earthworks LJSewage infrastructure
(JLandscaping (Signage L1Clearing vegetation
(_] Other — please specify:

 
 
    

 

   
  
  
 

 

 
 
 
   
 

14.2) Is the operational work necessary to facilitate the creation of-few lots? (e.g. subdivision)
L Yes - specify number of new lots:
LJ No
14.3) What is the monetary value of the proposed operational work? (include GST, materials and labour)
$

 
    
 

PART 4 — ASSESSMENT MANAGER DETAILS

15) Identify the assessment manager(s) who will be assessing this development application

 
 
 
  

  
  

16) Has the local government agreed to apply a superseded planning scheme for this development application?

C] Yes — a copy of the decisionnotice is attached to this development application
(_]Local government} is taken to have agreed to the superseded planning scheme request — relevant documents attache

No
PART 5 — REFERRAL DETAILS

17) Do any aspects of the proposed development require referral for any referral requirements?
Note: A development application will require referral if prescribed by the Planning eee ely 2017

[J No,there are no referral requirements relevant to any cen aspects identified in this development application
— proceed to Part 6

Matters requiring referral to the chief executive of the Planning Regulation 2017:

LJ Clearing native vegetation
(J Contaminated land(unexploded ordnance)
CJ Environmentally relevant activities (ERA)(only if the ERA have not been devolved to a local government)

 
  

     

 

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Department of Infrastructure, Local Government and

 

LFisheries — aquaculture

LFisheries — declared fish habitat area

(Fisheries — marine plants

(Fisheries -waterway barrier works

C] Hazardous chemical facilities

(_] Queensland heritage place(on or near a Queensland heritage place)

] Infrastructure — designated premises

(J Infrastructure — state transport infrastructure

CJ Infrastructure — state transport corridors and future state transportcorridors

(J Infrastructure — state-controlled transport tunnels and future state-controlled transport tunnels
CInfrastructure — state-controlled roads

C]Land within Port of Brisbane’s port limits j

(] SEQ development area

_] SEQ regional landscape and rural production area or SEQ Rural living area— community activity
LJSEQ regional landscape and rural production area or SEQ Rural living area — indoor recreation ~
LISEQ regional landscape and rural production area or SEQ Ruraf'living area — residential development
LISEQ regional landscape and rural production area or SEQ Rural! living area — urban activity

L Tidal works or works in a coastal management district

CJ Urban design

(_Water-related development — taking or interfering with water

(_JWater-related development —removing quarry material (from a watercourse or lake)

(_]Water-related development — referable dams

(_JWater-related development — construction of new levees or modification of existing levees (category 2 or 3 levees only)
(J Wetland protection area

Matters requiring referral to the local government:

(Airport land

CJ Environmentally relevant activities (ERA) (only if the ERA have been devolved to local government)
Local heritage places

Matters requiring referral to the chief executive of the distribution entity or transmission entity:
L] Electricity infrastructure

 

 

 

 

Matters requiring referral to:

e The chief executive of the holder of the licence, if not an individual
e The holder of the licence, if the holder of the licence is an individual

CJ Oil and gas infrastructure

Matters requiring referral to theBrisbane City Council:
LBrisbane core port land oS

Matters requiring referral to the Minister under the Transport Infrastructure Act 1994:
(]Brisbane core port land

(Strategic port land

Matters requiring referral to the relevant port operator:

LBrisbane core port land (below high-water mark and within port limits)

 

 

 

 

Matters requiring referral to the chief executive of the relevant port authority:
(Land within limits of another port

 

Matters requiring referral to the Gold Coast Waterways Authority:
C] Tidal works, or development in a coastal management district in Gold Coast waters

 

Matters requiring referral to the Queensland Fire and Emergency Service:
LJ Tidal works, or development in a coastal management district

) Has any referral agency provided a referral response for this development application?

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Department of Infrastructure, Local Government and P

 

 

L Yes - referral response(s) received and listed below are attached to this development application
LINo :

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 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

[/| | agree to receive an information request if determined necessary for this development application’
(1) 1 do not agree to accept an information request for this development application
Note: By not agreeing to accept an information request |, 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 applicationare not obligated under the DA Rules to accept any
additional information provided by the applicant for the development application wnless agreed to by the relevant parties

e Part 3 of the DA Rules will still apply if the application is an application listed undér section 11.3 of the DA Rules.
Further adviceabout 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)
C1 Yes —provide details below or include details in a schedule to this development application
.KINo

List of approval/development Reference number Date Assessment manager
application references

 

 

 

C1 Approval
(_] Development application

C] Approval
LJ Development application

 

 

 

 

 

 

21) Has the portable long service leave levy been paid? (only applicable to development applications involving building work or

operational work)

L Yes — the yellow local government/private certifier's copy of the receipted QLeave form is attached to this
development application ,

LJ No -1, the applicant will provide evidence that the portable long service leave levy has been paid before the
assessment manager decides the development application. | acknowledge that the assessment manager may give a
deyélopment approval only if | provide evidence that the portable long service leave levy has been paid

Not applicable
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?

(Yes — show cause or enforcement notice is attached
No

   

 

 

 

 

 

 

 

Further legislative requirements

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Department of Infrastructure, Local Government and Pl.

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?

CJ Yes — the required attachment (form EM941) for an application for an environmental authorityaccompanies this
ne application, and details are provided in the table below
No

Note: Application for an environmental authority can be found by searching “EM941” at www.qld.gov.au. An ERA requires an environmental authority
to operate. See www. business. gid.gov.aufor further information.

 

 

Proposed ERA number: Proposed ERA threshold:
Proposed ERA name:

O Multiple ERAs are applicable to this development application and the details have been attached in a schedule
to this development application.

Hazardous chemical fac

 

 

 

       
   

2)ls this development application for a hazardous chemical facility?

CJ Yes - Form 69: Notification of a facility exceeding 10% of schedule 15 thresholdis attached to this development
application
4) No

Note: See www.justice. qid.gov.aufor further information.

 

 

Clearing native vegetation
23.3) Does this development application involve clearing native vegetation that requires written confirmation 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?

L] Yes — this development application is accompanied by written confirmation from the chief executive of the

Vegetation Management Act 1999 (s22A determination)
No

Note: See www.qld.gov.au for further information.

   

Environmental offsets

23.4) Is this development application taken to be a prescribed actiyity that may have a significant residual impact on a
prescribed environmental matter under the Environmental Offsets Act 2014?

C1 Yes - | acknowledge that an environmental offset must be provided for any prescribed activity assessed as having a
significant residual impact on a prescribed environmental matter 4

No Se
Note: The environmental offset section of the Queensland Government's website can be accessed at www.qld.gov.au for further information on
environmental offsets.

Koala conservation

23.5)Does this development application involve a material change of use, reconfiguring a lot or operational work within
an assessable development area under Schedule 10, Part 10 of the Planning Regulation 2017?

No.

| Note: See guidance materials at www.ehp.qid.gov.au for further information.

 

 

 

   

Water resources

23.6) Does this development application involve taking or interfering with artesian or sub artesian water, taking or
interfering with water in a watercourse, lake or spring, taking overland flow water or waterway barrier works?

i the relevant template is completed and attached to this development application
:

Note: DA templates are available from www.dilgp.qid.gov.au.

23.7) Does this application involvetaking or interfering with artesian or sub artesian water, taking or interfering
with water in a watercourse, lake or spring, or taking overland flow waterunder the Water Act 2000?

L] Yes —| acknowledge that a relevant water authorisationunder tse Water Act 2000may be required prior to
commencing development

 

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Department of Infrastructure, Local Government and P

 

 

he
(1 No :
Note: Contact the Department of Natural Resources and Mines at www.dnrm.gid.gov.au for further information.

    
    
    

Marine activities
23.8)Does this development application involveaquaculture, 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.qid.qov.au for further information.
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?
LJ Yes —1 acknowledge that a quarry material allocation notice must be obtained prior to commencing development
FANo ‘
Note: Contact the Department of Natural Resources and Mines at www.dnrm.gid.qev.au for further information.

Quarry materials from land under tidal waters

23.10) Does this development application involve the removal of Peay materials from land under tidal water under
the Coastal Protection and Management Act 1995? ~~
LJ Yes —! acknowledge that a quarry material allocation notice must be obtained prior to commencing development
6 S
Note: Contact the Department of Environment and Heritage Protection at www.ehp.qid.gov.au for further information.

Referable dams

23.11) Does thisdevelopment 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)?

C1 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.dews.qid.gov.aufor further information.

Tidal work or development within a coastal management district

23.12) Does this development application involvetidal work or development in a coastal management district?

C1 Yes — the following is included with this development application:
(J Evidence the proposal meets the code for assessable deyelopmentthat is preseribed tidal work (only required if
application involves prescribed tidal work) 3
LIA certificate of title

No

Note: See guidance materials at www.ehp.qid.gov.au for further information.

Queensland and local he

   

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'sLocal Heritage Register?

(1 Yes — details of the heritage place are provided in the table below
N

10
Note: See guidance materials at www.ehp.qid.gov.au for information requirements regarding development of Queensland heritage places.

 

Name of the heritage place: Place ID:
Brothels

23.14) Doesthis development application involve a material change of use for a brothel?

 

(1 Yes — this development application demonstrates how the proposal meets the code fora development application for
a under Schedule 3 of the Prostitution Regulation 2014
No

 

 

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Department of Infrastructure, Local Government and

 

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?

CJ Yes -this application will be taken to be an application for a dec sionunder section 62 of the Transport Infrastructure
Act 1994(subject to the conditions in section 75 of the Transport Infrastructure Act 1994 being satisfied)

iO

 

PART 8 — CHECKLIST AND APPLICANT DECLARATION

24) Development application checklist

| have identified the assessment managerin question 15 and all relevant referral

 

requirement(s) in question 17 [Yes
Note: See thePlanning Regulation 2017 for referral requirements
If building work is associated with the proposed development, Parts4 to 6 of Form 2- [Yes

Building work details have been completed and attached to this development application C1 Not applicable

 

Supporting information addressing any applicable assessment benchmarks is with
development application

Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report Les
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 [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 C1 Yes
development permit is issued (see 21)) CT Not applicable

 

 

25) Applicant declaration

[J By making this development application, | declare that all information in this development application is true and

correct )

[AWhere an email address is provided in Part 1 ofthis form, | consentto receive future electronic communications from

the assessment manager and any referral agencyfor 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 201’

and the DA Rules except where:

e such disclosure is in accordance with the provisions about public access to documents contained in the Plannin
Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and Plannin
Regulation 2017; or

e required by other legislation (including the Right to Information Act 2009); or

e 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. ’

 

 

 

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Department of Infrastructure, Local Government and Ple

 

PART 9 — FOR OFFICE USE ONLY

Date received: [ss 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

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 Rulesare 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.

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