07/1873 - Preliminary Building Works Assessable against planning scheme [As Published] · 172007.1873

INTEGRATED PLANNING ACT 1997
Land owner's consent (if applicable)

Saction 3.2.1(3) of the IPA prescribes that an

[ epplicaion must contain, or be supported by, the
{writien consent of the land owners, if the application
| involves:

iy a material change of use;

‘fi reconfiguration of 2 bot

1) work on tand below high-water mark & not within @
¢ canal es defined under the Coastal Protection and
{ _ Management Act 1995;0r

{fv) work on rail corridor land defined under the

1 Transport infrastructure Act 1994.

Section 3.8.1(2){a) of the IPA provides that
landowner's consent is pot required for a mobile or

* temporary ERA .

3 For more information refer to Guide 1

20. Land owner's consent to the making of this application:

Part A, Version 2.4, 29 May 2006

 

 

 

 

 

 

Name Signature Date
9 hea 2 Phin Tort oeccceeccceeeeeceeeeceeeeseneefeeesseseees
(i)
wees
f@ 0 fee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

“Resource entitlement (if applicable) 21. Does this application involve a State resource prescribed under a regulation (other than involving
, Sexton 3.2.46) of the IPA requires evidence of quany material on State coastal land under the Coastal Protection and Management Act 1995)?
resource entitlement be given for applications that
involve a presoribed State resource. LANO - g0 to a24 [7] YES - go to.022
Sata a en sean naan 22. This application is accompanied by evidence: (tick applicable box)
without evidence of the resource entiiement (1 (i) of the allocation of, or entitlement to, the resource - attach evidence and go to 023(v)
* Advice for completing 071 & 22
Refer to schedule 10 of the intagrated Planning (1 fii) the chief executive of the department administering the resource is satisfied the
” Regulation 1998 thal prascribes the nature of eviden j is con i i -
“aud oY the Sista insupportot the ‘edging Sf he development is consistent with an allocation of, or entittement to, the resource - go
felopment application.

(J (ili) the chief executive of the department administering the resource is satisfied the
development application may-proceed in the absence of an allocation of, or
entitlement to, the resource — go to Q23

: Advice for completing 023 23. Evidence of the resource entitlement:
requred une 23 erence” | i) Resoures entitlement / authority details (vi) Offical stamp of the department
Reset Sana ec
‘Resources, Mines and Water is mandatory where the . applicable)
application involves any water or riverine quary {ii} Name of delegated officer
metro Cd
Section 3.2.1{5A) allows the a ae to ft
the time the avid be used. i} must ‘il iti
Toad Ee cae eee O25 (4) ms (ii) Position of a Officer

{iv) Signature of delegated officer :

(v) Date

(vi) pe date of evidence a

‘Assessment triggers 24. Is the IDAS Assessment Checklist completed and attached to this application?

; This checkiist does pet apply i the application requires (Yes [1] NO ~ the assessment fuse to

ithe completion of Parts A and B ofthe F It manager may refuse to accept this appication onthe
“Tusk be comps tor al ter aplication " grounds thet the epplication has not been properly made .

Plans / drawings / repo! . Plans/drawings/re accompanying this application:

Plans / drawings / reports 25. Plans/drawings/reports ac thi licati

; An application should be accompanied by details to
‘support the proposal & enable the assessment

s manages, referral agencies and any person viewing

* the application during public scrutiny or public
notification to understand the scope of the proposal

+ and any potential impact. .
r

 

 

Plan / Drawing / Report Number

 

 

 

 

 

 

 

PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide all applicable information required by Part A
and any other relevant part of Form 1.

 

OFFICE USE ONLY (eppticabie to ssessmient manager's}

 

 

 

[em 650 | ene [17/9/25 [ee PS OS | eee mes O(. 273_|
SS Nall ication of Engagement of Private Certifier (Optiona! forma}
To. Council. | have been engaged as the private certifier for the building work referred to in this application.

 

 

Oateofengagement / /

Accreditation Number.

Name:

Signature: