Development Application part 1 of 2 Application Forms OPW13/0004

           ODD
     Table C-premises coordinates (appropriate for development in remote
                                                                              areas, over part of a lot or in water e.g. channel
     dredging in Moreton Bay)

     Coordinates                                                            Zone         Datum               local government
     (note:place each set of coordinates in a separate row)                 reference                        area   (if applicable)
     Easting         Northing          Latitude          Longitude



                                                                                         D GDA94
                                                                                         D WGS84
                                                                                         D other


     5. Total area of the premises on which the development is proposed (indicate hectares or m2)




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



    I "5   tlO (7(.? ll\               C$N(YLtV

    7. Provide a brief description of the proposal (e.g.six unit apartment building, 30 lot residential subdivision etc.)



     ~NLr1:~tt~                 ’0,>
                                       P&~1 ft~~~                    To        S:-X1S/’~                    (\/rt{1t,
                                                                                                         5 ((
      A-1)           N’~vJ             <3 f(,
                                                rJ   -


                                                          _rl2          (Jf?{!._        PLA1vV$           f~Ol/l~~                 .




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


    D      No


    ~YeS-ComPlete        either table D. table E or table F as applicable



    Table D

    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




                 3                                                                          Application details-IOAS form :l
                                                                                              Version 1.0 18Oecember 2009