0015CF9E.001

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                  INTEGRATED PLANNING ACT 1997                                                                                           Form 2, Version 3.1, 18 November 2005
                 | Applicant details                         112,  Name:
                  Ctearly identify who is making the application. °|    CBD            SéETT cee2!s               COVE           PIN        LTD
                  The applicant need not be the owner ofthe  =|                                  :
                 | land.                      leapplication | 13.  Postal address:                                               .
                       Se                ene |                       PO         20%          '423 NOCSA HEADS, QLD US67 |
                 | The applicant is responsible for ensuring the       PO              XK      !423          N             tt          Ss     Q                67
                  information provided is correct. The               .                             ;                                                 .
                  assessment manager, any referral agency and | 14. Signature:                                                             15.  Date:
                  the Chief Executive (where applicable) will rely        yy
                  on this information when assessing and                                                                                            }    /       |
                  deciding the application.                                41      F Y (U'4-——F                                                       7[0S[O7
                   If the applicant Is a company                   :               y.                                                                                             ‘
                  A contact person must be shown. All     ~   116. Contget person:                   :                  .        .                _
                  correspondence will be mailed to this address.       CARLY          Ct ODFREY
                                                           ‘117. Telephone number:                               18.  Mobile number: fifappiicable)
                                   |                                (ODS443                     C166                      OW?           IB?            146               |
                                                              19.   Fax number: (ifapplicable)                   20.  Email address: (if     appticable,
                                a                                  | (07)        S443           0286
                  | Land owner/s consent (if applicable)      21.   Name (in ful)    -          :                                     _
                   Section 3.2.1(10}(a) of the IPA prescribes that |  GARN              MICHAEL              GoDFR
                   an application can not be taken to be properly                                  ;
      .            made without the land owner's consent.     22.   Sicnature                         ;                                  ‘23.  Date:
                  | For information about land owners refer to |
                  | Guide.1_ Making an DAS development  =—=s |                                                                                         [:
                  1 application.                                                                                                                  17(0S I oO?
                   For a mobile or temporary ERA                                                    -
                   Land owner's consent is not required.     :     ;
                   if an owner has signed this form as       .                                                                                                                         ,
                  | applicant
                   Their signature is not required again in this                                 :
                   section.
:                  If there are multiple owners
                   The consent of each owner is required.                                       .
                   Ifthe owner is a company                                                                                                                          ,
                  | Refer to Guide 1.
                  j Resource entitlement (if applicable)     24, wr this application involve taking or interfering with a State resource?
                  ' Section 3.2.1(10)(b) of the IPA prescribes that     NO - go fo  027                           YES -
                  an application can not be taken to be property              goto a                         C)          go to 025
                   ma   wou evidence of the resource          25.   This application is required by regulation to be accompanied by: (tick the applicable box)
                   enttlemen
                   Advice for completing Q25                        (J {i)  evidence of the allocation of, or entitlement to, the resource - attach evidence
                   Refer to schedule 10 of the integrated Plannii        .     .              .        a.                           aren                       .     .
                   Regulation 1998 that prescribes the nature Of    C1 (ii)  evidence the chief executive of the department administering the resource is satisfied
                  t evidence required by the State in support of the         the development is consistent with an allocation of, or entitlement to, the resource -
                   lodging of this development application.                  go fo Q 26                                              ,
                                                                   ‘C1 (ili) evidence 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 fo Q 26.            ,
                   Advice for complating Q2                   26.. Evidence of the resource entitlement:
                   The information in {i} - (v) is mandatory if      .                  .                 .       ,               7             .
                  evidence is required under Q25 (i) or (ii) above. {i)   Resource entitlement / authority   details                  {iv) Official stamp of the
                  + The official stamp of the Department of Natural                                                                        department administering
                   Resources and Mines is mandatory where the        .                                                                     the resource {if applicable
                  | application invalves taking or interfering with {ii} Name of delegated officer
                   water or riverine quarry material under the
                   Water Act 2000.                                   .        —                                                    :
                                                                    {iii} Position of — officer
                                                                   (iv)   ~ of ~ officer
                                                                     (v}  Date                                                                                 :            |