07/1172 - MCU - New Dwelling [As Published] · 132007.1172

 

NTEGRATERLANNG ACT 1997 . Parl A, Version 2.4, 29 May 2006
Land owner’s consent (if applicable) 20. Land owner's consent to the making of this application:

Section 3.2.1(3) of ihe IPA prescribes thal an

application must contain, or be supported by, the

writlen consent of the land owner/s, if the application : .

involves: (i) - "See Attached

(i) a material change of use;

(ii) reconfiguration of a tot; .

(ii) work on land below high-water mark & not within a (ii)
canal as defined under the Coasial Protection and
Management Aci 1995.08

(iv) work on rait corridor land defined under the
Transport Infrastructure Act 1994.

Section 3.8.1(2)(a) of the IPA provides that

landowner’s consenlis not required for a mobile or

temporary ERA.

Far more information refers to Guide 1,

 

Name Signature Date

 

 

 

 

 

 

 

 

 

Resource entitlement (if applicable) 21. Does this application involve a State resource prescribed under a regulation (other than involving
Section 3.2.1(8) of ihe IPA requis evidence a quarry material on State coastal land under the Coastal Protection and Management Act 1995)?

tesource entillement be given for applications that

involve a prescribed Slate resource. & NO - goto Q24 O YES - go to 022

Section 3.2.1(10}(a)(i) of the IPA prescribes that : cactinn te dhe : . . ,
application ote ae lo be properly made. "122. This application is accompanied by evidence: (tick applicable box)

inion evidence oe ee sane, (1 (i) of the allocation of, or entitlement to, the resource - attach evidence and go to 23(vi)

vice for completing . eo . . woe . ' .

Refer lo schedule 10 of the Integrated Planning Ci (ii) the chief executive of the department administering the resource is satisfied the

~ Regulation 1998 thal prescribes the nature of evidence development is consistent with an allocation of, or entitlement to, the resource - go
tequired by (he State in supporl of the lodging of this to 023

development application, .
L (iii) the chief executive of the department administering the resource is satisfied the

bee teeene safe ~ -~development application may proceed in the absence of.an allocation of, or -. ~
entittement to, the resource - go to 023 :

Advise for completing 023 : 23, Evidence of the resource entitlement:
The information in (i) - {v) is mandatory if evidence is

required under O22 (i) or (i) above. (i) Resource entitlement / authority details (vii) ofr stamp of the department
The official stamp of the Department of Natura} - a ministering the resource (if
Resources, Mines and Waler is mandatory where the 7 applicable)

application involves any water or riverine quarry. (ii) Name of delegated officer

Seren 12150 slo hence eager ok Cd
Section 3.2.1{5A) allows the resource manager to limit

the time the evidence may be used. 023 (vi) must be (iii) Position of delegated officer

completed if the evidence is time limited, CO

(iv) Signature of delegated officer

 

 

 

 

 

(v) Date

(vi) =m date of evidence a

 

 

 

 

 

 

 

 

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

rhecompllon of Pas sep ohe tomers he &] YES (J NO - the assessment manager may refuse fo accep! this application on the
must be completed for all olher applications, grounds that the application has not been properly made

Plans / drawings / reports 25. Plans/drawings/reports accompanying this application: .

ssid te pm cas Pan raving! Report Number Tie Dae

 

manager, referral agencies and any person viewing
the application during public scrutiny or public .
nolificalion lo undersland the scope ofthe proposal «| 0 fr ttt rrr ttt ttc rrr ttre creer rcs terre dace c sere eer eee ssn we erences anna beeen een eens
and any potential impact. .

 

 

 

 

 

 

 

 

 

PLEASE NOTE: The assessment manager may refuse 10 accept an application that, at the time of todgement, {ails to provide all applicable information required by Part A
and any other relevant part of Form 1.

 

OFFICE USE ONLY (applicable to assessment manager's)

 

 

 

 

 

 

 

DATE j  PRECEIVING OFFICERS ] no o> REFERENCE T 4
FEES) SOL | Receveo | S]tefer i NAMEIS p Ge, wees |OT(W7e |
i Hatlicatlon of Engagement of Private Certiflor (Optione! ‘oma

i a; on aps

i Ta Council. ! hve been engaged as the private certifier for the building work referred to in this application.

 

efengegement! / 7 — Actreditation Number. __. Name:, Signature: