Development Application part 1 of 2 Application Forms MCU11/0198

FROM                                                                 -MON>SEP 26 2011      9:27/ST. 9:27/No.6951018860 P 2




       2. What type of approval Is being sought?


           development permit

       q   preliminary approval

       q   both - provide details below



       3. Is the application for a mobile and temporary environmentally relevant activity (ERA)?


       ® No

       q      Yes - complete table A and then go to question 5




       4. Location of the premises (complete table B and/or table C as applicable. Identify each lot in a separate row)

       Table B - street addressAot for the premises or street address/lot on plan for the land adjoining or adjacent to the
       premises

                                                                                    Lot on plan
                       Street Address
                                                                                    description
                                                                                                        Local government area
                       Unit Street I      Street name and official        Post I       I Plan type I      (e.g. Logan,Cairns)
                       No. I No.           suburb/locality name           code Lot No. and plan no.

                                       Black Mountain Road
                  1I        1528                                                5       1 RP 227335 1 SCRC (Maroochy)
                                       BLACK MOUNTAIN
           Street address / lot on plan
           Street address / lot on plan for the land adjoining or adjacent to the premises (appropriate for development in
           water e.g. jetty, pontoon)
       Table C - premises coordinates (appropriate for development in remote areas, over part of a lot or in water e.g.
       channel dredging in Moreton Bay)

                       Coordinates (note: place each set of
                       coordinates in a separate row)                         Zone                           Local government
                                                                                             Datum
                                                                            reference                        area (If applicable)
                        Easting j Northing        Latitude    Longitude

                                                                                        q GDA94
                                                                                        q WGS84
                  1
                                                                                        q other

       5. Total area of the promises on which the development is proposed (indicate hectares or m')

        2ha
       6. Current uses of the premises (e.g. vacant land, house, apartment building, cane farm, etc.)



                El     Vacant



       17. Provide a brief description of the proposal (e.g. six unit apartment building, 30 lot residential subdivision etc.)


        New Dwelling




                                                                                                     Apphr'wton Deta)ls   IDAS form I
                                                                                                       Ver Sion 10 18 December 2009