Development Application part 1 of 2 Application Forms MCU11/0198

FROM                                                                  !MON)SEP 26 2011        9:28/ST. 9:27/No.6951C18860 P 3




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           8. 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 D, table E or table F as applicable



           9. Does the application invohre 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)

           1X No                            q Yes - complete table G



           10. 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

           q       on strategic port land under the Transport Infrastructure Act 1994 - complete table I

                   in a 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.)

           q No ® Yes - ensure the type, location and dimension of each easement is included in the plans submitted


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

           q No ® Yes - ensure the nature. location and dimensions of proposed works are included in plans submitted

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

           q No - Go to question 15                    ® Yes




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


           ® No
                         complete table K and submit with this application the yellow local government/ private certifier's copy of
           q Yes -
                         the receipted QLeave Form



            S. Has the local government agreed to apply a superseded planning scheme to this application under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


                No
           []   Yes - provide details below




                                                                                                       Application Derails IDAS form 1
                                                                                                         Vernon 1.0 18 December 2009