10/0662 - Operational Works [As Published] · 142010.662

oon

 

& is owher's consent required for this application? (refer to notes at the end of this form for more information)

 

 

 

[] No
—X] Yes - complete either table D, table E or table F as applicable

 

Table D (note: do not complete this table if lodging the application on-line using Smart eDA)

 

 

Name of owner/s of the land

 

We, the above-mentioned owner/s of the land, consent to the making of this application.

 

Signature of owner/s of the land

 

 

Date

 

 

Table E

 

 

@rame of owner/s of the land

 

 

{"] The owner's written consent is attached or will be provided separately to the assessment manager

 

Table F

 

 

 

Name of owner/s of the land [Nikola Tokovic

 

Xi By making this application, |, the applicant, declare that the owner has given written consent to the making of
the application.

 

 

9. Does the application involve a state resource? (e.g. the application involves state land, or taking quarry
materials. Refer to the notes at the end of this form for more information)

 

 

—X] No L]Yes - complete table G

 

@;, Identify if any of the following apply to the premises (tick applicable box/es)

 

 

[] adjacent to a water body, watercourse or aquifer (e.g creek, river, lake, canal) - complete table H
[-} _ on strategic port land under the Transport Infrastructure Act 1994 - complete table |
LJ _ ina tidal water area - complete table J

 

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

 

 

[—X]No [(] Yes - ensure the type, location and dimension of each easement is included in the plans submitted

 

Application Details - IDAS form 7
Version 1.0 18 December 2009