MCU16/0036 Development application - 52 Gevers Rd, Black Mountain

                                                                           Department of Infrastructure, local Government and Planning



Table J

Lot on plan description for strategic port land                            Port authority for the lot




Table K

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




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

~     No      0      Ye~nsure         the type, location and dimension of each easement is included in the plans submitted


9.    Does the proposal          include    new building   work or operational   work on the premises?        (Including any
      services)

o     No      ~       Ye~nsure        the nature, location and dimension of proposed works are included in plans submitted

10.   Is the payment of a portable long service leave levy applicable                 to this application?   (Refer to notes at the
      end of this form for more information.)

~     No-go       to question 12           DYes

11.   Has the portable      long service       leave levy been paid? (Refer to notes at the end of this form for more
      information.)

o     No

o     Yes-complete   Table L and submit with this application the yellow local government/private
      receipted QLeave form
                                                                                                               certifier's copy of the



Table L

Amount paid                                                             Date paid          QLeave project number (6 digit number
                                                                       (dd/mmlyy)          starting with A, S, E, L or P)




12.   Has the local government agreed to apply a superseded                 planning     scheme to this application     under
      section 96 of the Sustainable Planning Act 2009?

~     No

o     Yes-please       provide details below


Name of local government                               Date of written notice given      Reference number of written notice given
                                                       by local government               by local government (if applicable)
                                                       (dd/mm/yy)




                                                                                                        IDAS form 1-Applicalion details
                                                                                                            Version 4.2-3 August 2015