Ida form 122052017 · OPW17/0180

 

Department of Infrastructure, Local Guvernment and Planning

2. Location of the premises (Complete Table D and/or Table E as applicable, Identify each lot in a separate row.)

Table D—Street address and |ot on plan for the premises or street address and lot on plan for the land adjoining or
adjacent to the premises (Note: this table is to be used for applications involving taking or interfering with water.)
(Attach a separate schedule if there is insufficient space in this table.)

[4 Street adaress and lot on plan (All lots must be listed.)

O Street address and lot on plan for the land adjoining or adjacent to the premises (Appropriate for
development in water but adjoining or adjacent to land, e.g. jetty, pontoon. All lots must be listed.)

      
  

   
   
 

 
 
  

Street address Lot on plan description | Local government area

(e.g. Logan, Cairns)

    

Street name and official suburh/
locality name

Plan type
and plan no.

 

| Planning scheme details (If the premises involves multiple zones, clearly identify the relevant zone/s for each lot in a
separate row in the below table, Non-mandatory)

Apolicable zone / precinct Applicable local plan / precinct

[@ | lle =l ———

Table E—Premises coordinates (Appropriate for development in remote areas, over part of a lot or in water not
adjoining or adjacent to land e.g. channel dredging in Moreton Bay.) (Attach a separate schedule if there Is Insufficient
space in this table.)

Coordinates Zone | Datum Local government

(Note: place each set of coordinates in a separate row) reference area (if applicable)
Northing Latitude

    

    
   

Applicable overlay/s

    

 

 

      

Easting Longitude

         

LC) apasa
C] weses
| other

3, Total area of land on which the development is proposed (indicate square metres)

a
4. Current use/s of the premises (e.c. vacant land, house, apartment building, cane farm etc.)

 

 

 

(DAS form 1—Application datails
Version 4.3—5 December 2018