2. EA application form

                                                                                                   Application form
            Development application Form 1 - Application details—attachment for an
                                         application for an environmental authority

The fields marked with an asterisk * are mandatory, if they are not completed then your application may
be considered not properly made under the Planning Act 2016.

1. Applicant details
To nominate a site or application contact for this application please provide details at Questions 14 and 15.

  Is there more than one              No—provide applicant’s details below.
  applicant? *                        Yes—provide the principal applicant’s details below and all other applicants’
                                      details in Attachment 1—“Joint applicants and appointment of principal applicant”

  Name - individual or contact person if applicant is a organisation*                Suitable Operator Reference
  Oscar Rogers                                                                       Number*
                                                                                     718168

  Organisation name, including any trading name (*if an organisation)                ABN/ACN (*if an organisation)
  Noosa Shire Council                                                                97 969 214 121
  Residential or registered business address (not a post office box)*                Phone*
  Level 1, 9 Pelican Street, Tewantin                                                07 5329 6512
  Postal address (if same as above, write “AS ABOVE”)*                               Facsimile
  As above
  Email*                                                                                   Indicate if you want to receive
  [email protected]                                                            correspondence via email


1.1 Nomination of an agent for this application
I/we nominate the below agent to act on my/our behalf and to receive correspondence relating to this
application.
  Do you want to nominate an agent for this application?*
     No → Go to Question Error! Reference source not found.
     Yes → Complete the agent’s details here.
  Name of agent – individual or contact person if agent is an organisation
  Martin Mulcahy

  Organisation name, including trading name if an organisation                       ABN/ACN (if an organisation)
  International Coastal Management                                                   62 010 927 796
  Postal address                                                                     Phone
  PO Box 306 Main beach QLD 4217                                                     07 5564 0564
  Email                                                                                    Indicate if you do not want to
  [email protected]                                                       receive correspondence via email


2. Details of the ERA(s) that you want to operate
Please list all of the ERAs that will be undertaken on site, including:
     •    Any existing ERAs will continue to operate unchanged on the site (select “Existing” in the table below);
     •    ERAs that are proposed to be undertaken on the site as part of the application (select “New - DA” in the
          table below); and
     •    ERAs that are proposed to be undertaken on this site, that don’t form part of this application as they do
          not require a DA (select “New - EA” in the table below).
Listing all the ERAs that will be undertaken on site will help enable them to all be included on the one EA



Page 3 of 12 • ESR/2015/1791 • Version 8.00 • Last reviewed: 12 AUG 2021          Department of Environment and Science