09/1405 - Suncert - Preliminary Building Works [As Published] · 172009.1405

INTEGRATED PLANNING ACT 1997 Part A, Version 3.1, 3 March 2008
Table D Complete if the premises are adjacent to or r associated w with a water body, wi watercourse or ‘aqui fe g. fiver, creek, lake, canal)

[i NIA

Table E Complete if the premises are on Strategic Port Land under the Transport infrastructure Act d 994
Cae = Loton plan: description for stfategic port land pat ont
| 1 NIA

 

  

 

 

 

 

 

 

 

Table F Complete if the premises are in tidal water

(1

3. indicate the total area of the premises on which the development is proposed: (Note: The total area may include land both above and below water}

 

 

 

 

 

 

 

 

Total atea of pramises 3 3.6

   

 

506.00 &)m? [hectares (Tick applicable unit)

 

 

 

 

 

(Existing use.of the premises “"i. ie eA ; :
4. Current use/s of the premises: (e.g. vacant land, house, townhouses, apartment building, shop, service station, school, sugar cane farming etc.)

 

[ 1 | Dwelling |

 

5. Are there any existing easements on the premises? (e.g. for vehicular access, electricity, overland flow, water etc.)?
>< No O Yes - Ensure the type, location and dimensions of each easement are included in plans, submitted with the application
rapes details, ae eho ke

6. Brief description of the proposal (e.g. 6 unit apartment building, 30 lot residential subdivision, a bore, aquaculture)

 

    

 

Dwelling Additions

 

 

 

7. Does the poposal include new buildings or operational work (including any services) on the premises?
O No & Yes - Ensure the nature, location and dimensions of the proposed works are included in plans, submitted with the application

 

  
 

een

‘Resource entitlement (if applicable) - further information is provided in the advice section at the 6nd of the form.

8, Does the application involve taking or interfering with a State resource and therefore require a a resource entitlement? (e.g. the application
involves State land {leased and freehold), declared Fish Habitat areas, taking quarry material, taking or interfering with water under the Water Act 2000, etc.)

) No - Gow ag OC Yes - Coinpiete Table G - provide details for each evidence required on a separate row, if applicable. Evidence of resource
allocation or entitlement must be submitted with the application, You do not need to answer Q9 - go to the next section.

Siil dicta cca

9, Complete Table H for applications involving a material change of use; reconfiguration of a lot; work on land below high-water mark and
not within a canal as defined under the Coastal Protection and Management Act 1995; or work on rail corridor land defined under the
Transport Infrastructure Act 1994 - provide details for each owner on a separate row, of on an attachment to this form if applicable.

 

 

{Owner’ 's consent {if applicable) » "- further information is provided in the advice "section at the end of the form.

 

a aang

 

 

 

 

* Premises Owners namels:

i '* Date-consent.”
and postal address * |

_ | was obtained

 

Table H

 

 

 
   
     

 

 

 

 

 

 

 

 

* Owner's signature cannot be provided on the form if you intend to submit the application electronically. Owner's consent must be provided to the assessment manager on an
attachment containing appropriate written documentation of the owner’s consent. If the owner is a company, $127 of the Corporations Act 2001 (Cwealth) details how a
company may sign as owner. Templates for the provision of owner's consent are available on the IPA wepsite .

Aachen

 

 

Table |

 

 

“al asséssment man

ee eta:

 

< alocationfentivement, plans, drawings, repods) x