0015D13F.001

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              INTEGRATED PLANNING ACT 1997                                                                                                  Part A, Version 2.4,
              Land owner’s consent (if applicable)        20.   Land owner's consent to the making of this application:
            spc            ania     espa                         Pp                  eme                      | Stanature                         |            ate
             application must contain, or be supported by, the                                                            4 Signature                        Date
             written consent of the land owners, if the appication 0 f                                           A,         Ce                           S. 6-07
              () 2 material change of use;                       _     tol Nested Kieran                             IT AY TT
              involves:                                            i                                                     z
              (@ reconfiguration of a lot;
              G9) work on land below high-water mark & not within a (ii)
                 Canal as defined under the Coastal Protection and oe ee eee eee n en ecccwenccncwcecececcbaccencceccccccanensccnececcccnscccdecccunnecceee
                  Management Act 1995.0r                           exe
              (tv) work on rail corridor land defined under the   (iii)
               Section 3.8.1{Z}a) of the IPA provides that         .
               landowner’s consent is not required for a mobile or {iv)
               For more information refer to Guide 1.            (v)
               Resource entitlement (if applicable)        21.  Does this    application involve a State resource prescribed under a regulation (other than involving
               Section 3.2.(5) of the IPA requires evidence of  quarry      méterial on State coastal land under the Coastal Protection and Management Act 1995)?
               resource entiement be givan for applications that
             involve a prescribed State resource.                     O - go to 024                       (1 YES - go fo q22
              Section 3.2.1(1  of the IPA prescribes that          .      ep                    .         .
              application canta te taken to be property made |22. This application is accompanied by evidence: (tick appiicable box)
@             without evidence of ie ae                         (1 @)_   of the allocation of, or entitlement to, the resource — atfach evidence and go to 023{u)
               Refer to schedule 10 of the integrated Planning  [_] (ii) the chief executive of the department administering the resource is satisfied the
              Reguiation 1998 that prescribes the nature of evidence                    ;        i                                      ,                           .
                  sod by the State in support of the lodging ofthis     development is consistent with an allocation of, or entitlement to, the resource — go
              development apptication.                               ws         .          .                            neg                       wg
                                                                1 {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 223 valor it edonoe     23.  Evidence of the resource entitlement:
               ado Oto isos                             |       (i)   Resource entitlement / authority    details              (vii) Official stamp of the department
               The offical stamp of the Department of Natural                                                                       administering the resource (if
               Resources, Mines and Water is mandatory where the .                                                                     ficable)
               application involves any water or riverine quarry (ii) Name of delegated officer
               material under the Water Act 2000.                     CY
               Section 3.2.1(5A) allows the resource manager to fimit
              the time the evidence may be used. 023 (vi} must be tii     iti
                   Tote tthe evvhionce s tne Ernted             (ii)  Position of    a officer
                                                                (iv)  P         of ~ officer
                                                                 (v}  Date
                                                                (vi)  Expiry  date of evidence (if applicable)

               Assessment triggers                         24.  ts the JOAS Assessment Checklist completed and attached to this application?
              Misheieinieers.-s sa niorvarseieh ony              A    YYES                    [INO - the assessment manager may refuse to accept this application on the
               must be completed for all other applications.                                             grounds that the application has not been properly made
               Plans | drawings / reports                  25.  Plans/drawings/reports accompanying this application:
              Sipe be opal eee fe eiesnat                               Plan / Drawing / Report Number
               anager, referral agencies and any person viewing     .
              the application during public scrutiny or public     (i)
               notification to understand the scope of the proposal wot retereccsa reese sesecenscaececesasces fearcoseecaser co cansosonaascecacs
              and any potential impact.                            (ii)
                                                                   (iii)
                                                                   (iv)
               PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide ail applicable information required by Part A
                                  and any other relevant part of Form 1.
                                                 ee eee en                    eee ener
              OFFICE USE ONLY (eppticabie to assessment manager's}
               een                   [tee |e ee
                                                RECEIVED                                  NAME/S                                       NUMBERIS
                                                         Notification of Engagement of Private Certifier (Optionat format}
                To                                                       Council. { have been engaged as the private certifier for the building work referred to in this application.
                Date ofengagement     /   /    Accreditation Number:                    ___ Name:                                Signature: