09/1490 - MCU - Detached House [As Published] · 132009.1490

INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008

Table D Complete if the premises are adjacent to or associated with a water body, watercourse or aquifer (e.g. river, creek, lake, canal)

 

Name of water body, watercourse or aquifer {if known)

 

}1 [NA

 

Table £ Complete if the premises are on Strategic Port Land under the Transport Infrastructure Act 1994
Lot on plan description for strategic port land Port Authority for the fot

 

 

 

E NA

 

Table F Complete if the premises are in tidal water
Name of local govemment for the tidal area (7 applicable) Name of port authority for the tidal area {if applicable)

 

 

}1 | NA

 

 

 

3. — Indicate the total area of the premises on which the development is proposed: (Note: The fota! area may include land both above and below water)

 

Total area of premises

 

 

 

 

 

 

1,041.00 m2 [ ] hectares (Tick applicable unit)
Existing use of the premises a 1

 

4. Current use/s of the premises: (e.g. vacant land, house, townhouses, apartment building, shop, service station, school, sugar cane farming etc.)

 

| 1 | vacant land |

5. Are there any existing easements on the premises? (e.g. for vehicular access, electricity, overtand flow, water etc.)?

([<] No —_[_] Yes - Ensure the type, location and dimensions of each easement are included in plans, submitted with the application
|Proposal details ]
6. Brief description of the proposal (e.g. 6 unit apartment building, 30 fot residential subdivision, a bore, aquacutture)

 

New residence & swimming poo!

 

 

 

7. Does the poposal include new buildings or operational work (including any services) on the premises?
[_] No Yes - Ensure the nature, location and dimensions of the proposed works are included in plans, submitted with the application

iResource entitlement {if applicable) _- further information is provided in the advice section at the end of the form. _ J

8. Does the application involve taking or interfering with a State resource and therefore require a resource entitlement? (6.9. the application
involves State land (leased and freehold), declared Fish Habitat areas, taking quarry material, taking or interfering with water under the Water Act 2000, etc.)

ix No -Ga fo Q9 [] Yes - Complete Table G - provide details for each evidence required on a separate row, if applicable. Evidence of resource
allocation or entitlement must be submitted with the application. You do not need to answer Q9 - go to the next section.
Owner's consent (if applicable) | - further information is provided in the advice section at the end of the form ]

9. Complete Table H for applications involving a material change of use; reconfiguration of a lot; work on land below high-water mark and
not within a canal as defined under the Coasta/ Protection and Management Act 7995: or work on rail corridor land defined under the
Transport Infrastructure Act 1994 - provide details for each owner on a separate row, or on an attachment to this form if applicable.

 

 

 

Table H Premises Owner's name/s Details of the premises owned Owner's siqnature* Date consent
able and postal address {street address or fot on plan description) a g was obtained
‘ Mr C Wilson 750/*1 Noosa Springs Drive .
PO Box 58 Eumundi 4562 | Noosa Heads Qld 4567 2 A. 10. OF

 

 

 

 

 

 

 

* Owner's signature cannot be provided on the form if you intend to submit the application electronically. Owner's consent must be provided to the assessment manager cn an
attachment containing appropriate written documentation of the owner's consent. If the owner is a company, $127 of the Corporations Act 2007 (Cwealth) details how a
company may sign as owner. Templates for the provision of owner's consent are available on the IPA website .

Attachments and supporting information (Complete Table | - Use a separate row for each type of attachment or information, including information required
lunder this Part} Please ensure all documentation submitted with (his form, including other Parts of Form 1, or owner's consent, etc, are securely attached to this Part of the Form.

 

Description of attachment or information Title ( . . .

; itle (if applicable} D Method of delivery to
J. . at A
lable | (ag Pat C of rom t ert plane, te ene of source (e.g. General Authority, Jamas StreetTraffic Report) e assessment anager

1 Part D |