11042017112249-0001 · MCU17/0031

Department of Infrastructure, Local Government and Planning

 

 

5. Are there any current approvals (e.g. a preliminary approval) associated with this application? (Non-
mandatory requirement)

 

i) [] Yes—provide details below

 

 

 

 

 

 

 

 

 

 

 

List of approval reference/s Date approved (dd/mm/yy) Date approval lapses (dd/mm/yy)
6. Is owner’s consent required for this application? (Refer to notes at the end of this form for more information.)
[] No
Yes—complete either Table F, Table G or Table H as applicable
Table F
Name of owner/s of the land L /o inf Ket wv Zutir8s Kez sy

an

 

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

 

Signature of owner/s of the land Ld Lat

 

 

oe BED (7 fhe 6

 

Table G

 

Name of owner/s of the land

 

CO The owner's written consent is attached or will be provided separately to the assessment manager.

 

 

Table H

 

 

Name of owner/s of the land

 

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

 

 

 

 

7 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, cana!)—complete Table |

On strategic port land under the Transport Infrastructure Act 1994—-complete Table J

In a tidal water area—complete Table K

On Brisbane core port land under the Transport Infrastructure Act 1994 (No table requires completion.)

On airport land under the Airport Assets (Restructuring and Disposal) Act 2008 (no table requires completion)

OOOOOd

Listed on either the Contaminated Land Register (CLR) or the Environmental Management Register (EMR) under
the Environmental Protection Act 1994 (no table requires completion)

 

Table |

 

Name of water body, watercourse or aquifer

 

 

 

 

IDAS form 1—Application details
Version 4.3—5 December 2016