Idas Forms 3032 · REC13/0095

                   Integrated Development Application System form

36420m2

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

Vacant land



5. Are there any current approvals (e.g. a preliminary approval) associated with this application? (Non-
mandatory requirement.)

       No            Yes—provide details below

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



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

       No
       Yes—complete either Table G, Table H or Table I as applicable

Table G

Name of owner/s of the land

I/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 H

Name of owner/s of the land

    The owner’s written consent is attached or will be provided separately to the assessment manager

Table I

Name of owner/s of the land

    By making this application, I, the applicant, declare that the owner has given written consent to the making of the
application.



7. Does the application involve a state resource? (E.g. the application involves taking water or quarry material, or
interfering with the flow of water. Refer to the notes at the end of this form for more information) (Non-mandatory
requirement.)

       No                      Not identified whether or        Yes—complete Table J
                               not the application
                               involves a State
                               resource


Table J

4                                                                                            IDAS form 1—Application details
                                                                                                  Version 2.0 31 March 2013