Ida form 122052017 · OPW17/0180

 

Department of Intrastructure, local Government and Planning

 

No [] Yes—provide details below

 

List of approval reference/s Date approved (dd/mmiyy) Date approval lapses (dd/mmiyy)

|
| 6. ls owner's consent required for this application? (Refer to notes at the end of this form for more information.)

No

 

oO Yes—compiete either Table F, Table G or Table H as applicable

Table F

Name of owner/s of the land

 

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

 

Signature of owner/s of the land =|

Date

Table G
Name of owner/s of the land

 
 
   
 

| :
| oO 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

C1] py 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, canal)—compiete Table |

 

 

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

In a tidal water area—complete Tabie 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)

OOOOOO

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

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Table |

Name of water body, watercourse or aquifer

IDAS farm t—Apniication details
Version 4.3-—5 Decambar 2016